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VO! UME. XXXVI, NO. 11° TABLE OF CONTENTS, PAGE 613
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TABLE OF CONTENTS
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The RHODE ISLAND MEDICAL JOURNAL
Editorial and Business Office: 106 Francis Street, Providence, R. I.
Editor-in-Chief: PETER P1ngco CHASE, M.D.
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Volume XXXVIII, No. 11 November, 1955
TABLE OF CONTENTS
PAGE
RHEUMATOID ARTHRITIS, Fifteen Years’ Experience With Chrysotherapy,
Me I I I iis css sahil dca apd Soieaaaia ease Rian esddcdaieahclan taint 623
THE MEDICAL ADVISORY COMMITTEE AND THE DISABILITY FREEZE
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eee eee eee S Bee, MR 630
THE BEGINNINGS OF MEDICAL EDUCATION IN RHODE ISLAND,
Part III, Seebert J. Goldows key, M.Do.....:ccccscsicsssssusscsieisienntisieuenenatuenenenatieueieneniasees 632
WHAT HAVE YOU TO SAY ABOUT HOSPITAL ACCREDITATION ?.... 662
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The RHODE ISLAND MEDICAL JOURNAL
VOL. XXXVIII
NOVEMBER, 1955
NO. 11
RHEUMATOID ARTHRITIS
Fifteen Years’ Experience With Chrysotherapy
Jos&= M. RAMOs, M.D.
The Author. José M. Ramos, M.D., of Newport,
Rhode Island. Senior Physician and Director of Arth-
ritis Clinic, Newport Flospital.
A. History of Chrysotherapy
_ usE of gold as a therapeutic agent for rheu-
matoid arthritis is not new. Lande, in Germany,
was the first reported to have used this agent for
this disease as far back as 1929, but the greatest
impetus to its use was given by Jacques Forestier at
Aix-les-Bains, France, in 1929.
His use of this form of therapy was based on
the knowledge that gold salts could inhibit growth
of tubercule bacilli in vitro. This fact had been
reported in 1890 by Koch. Later, other workers
reported that gold preparations containing a sulf-
hydryl (SH) group possessed antibacterial proper-
ties,and much was done in the study of gold prepara-
tions in treating skin disorders which were consid-
ered to be related to tuberculosis such as lupus
erythematosis, eczema and psoriasis.
Because of some clinical similarities between
rheumatoid arthritis and tuberculosis, it seemed
reasonable to Forestier to assume that gold salts
might help the rheumatoid patients. This reasoning
was also based on the knowledge that gold had an
affinity for serous membranes such as the pleura
and the synovial membranes. As Copeman and his
workers had realized, gold was present in the syno-
vial membranes in much higher concentrations than
in the muscle, and that the gold content of the syno-
vial membranes of the arthritic joints was much
higher than in the synovial membranes of normal
joints. ;
During the past ten years much has been learned
concerning the gold compounds, their pharmacol-
ogy and metabolism and this has made for a more
intellivent use of gold in its application to rheuma-
toid activity.
B. Mode of Action
The way in which gold compounds act in the
human organism when used for treatment of rheu-
matoid activity is still a matter of conjecture. Vari-
ous tissue biopsies of patients who had received
radioactive gold as gold sodium thiosulfate showed
that there was a much higher concentration in the
synovial membranes and fluid than in muscle, fascia
or skin. It is varied mainly in the plasma compo-
nents of the blood, most probably bound to the
plasma proteins.
The failure of gold to protect guinea pigs against
large doses of histamine, and the absence of an
effect of Arthus phenomenon did not suggest that
it had an antiallergic action.
Since particles of gold had been found in the
reticulo-endothelial cells, it was thought that pos-
sibly gold stimulated the reticulo-endothelial sys-
tem. There has been no evidence to support this
theory.
Another theory suggested that gold compounds
might exert their therapeutic effect by changing
tissue enzyme reaction. In vitro studies on rat tis-
sues failed to confirm this hypothesis.
Lately some workers have had the opinion that
gold compounds may, perhaps, stimulate the adre-
nal cortex, and thereby produce their therapeutic
effect. Much work was done to disprove this theory
by Bruce and Mackay at the North Royal Infirm-
ary, in Inverness, Scotland. They investigated to
see what changes, if any, took place in the urinary
excretion of neutral 17-ketosteroids in the cases
that were selected for gold therapy, and found that
chrysotherapy did not produce any change in the
17-ketosteroid excretion level in the cases that bene-
fited from this therapy.
Davison, Koets, Kuzell and others also found the
ketosteroid excretion to be within the normal range
in these cases and suggested that cases of rheuma-
toid arthritis deriving benefit from chrysotherapy
could not attribute their improvement to any action
on the adrenal cortex.
C. Administration of Gold
There are various preparations of gold repre-
continued on next page
623
624
senting different chemical and physical types of
gold compounds. The gold preparations most fre-
quently used are: 1) Sanochrysine, a gold sodium
thiosulfate solution, soluble in water and containing
37% gold. 2) Myochrysine, a gold sodium thioma-
late, also soluble in water, and containing 50% gold.
3) Solganol-B Oleosum, a gold thioglucose in oil
suspension and also containing 50% gold.
The latter form, or Solganol-B Oleosum, was
used almost exclusively throughout these series of
cases during at least twelve of the fifteen years of
therapy of rheumatoid cases. During the first three
years Gold Sodium Thiosulfate (Abbott ) was used
in intravenous doses of 10 and 25 mgm. Retro-
spectively one appreciates the latter method as hav-
ing been really an heroic mode of therapy given its
extremely rapid absorption and its high blood con-
centration a few hours after injection. The re-
actions to gold were frequent and sometimes severe
depending upon the individual susceptibility.
An oil suspension of a soluble gold salt such as
gold thioglucose given intramuscularly is slowly ab-
sorbed, and produces lower plasma gold concentra-
tions with less frequency of reactions to gold. This
oil suspension was used by us not because of its
superiority to either Sanochrysine or Myochrysine,
but merely due to the fact that it was a product that
we had been accustomed to handling and were
familiar with its various reactions and the various
individual idiosyncrasies that were associated with
it.
The all-important factor in the use of Chryso-
therapy reduces itself to the routine in which the
gold compound is administered, or the schedule that
is applied in cases of rheumatoid activity.
Until 1945, the routine that was customarily used
and applied in this office, was the administration of
gold in graded doses beginning with 10 mgm.
weekly for four weeks and then 25 mgm. weekly
for four weeks with a continuance of 50 mgm.
weekly until a total dose of 1 to 2 gms. of the drug
had been administered. This routine was modified
by the reaction of the individual to gold or inter-
rupted entirely according to the severity of the toxic
symptoms. A rest period of two months was then
given and another course, or as many of four
courses, were given until a satisfactory outcome
was reached and no further relapses occurred. This
was recognized as the method ‘tad modum Stein-
brocker.”
The method used by us since 1945 was a slight
modification of this schedule, taking into considera-
tion the fact that among patients receiving higher
doses of gold compounds there was a tendency to-
ward greater improvement but also towards in-
creased toxicity. A fairly good compromise was
reached with a schedule which, we think, gave good
end results and at the same time circumvented the
highly toxic reactions of the drug.
RHODE ISLAND MEDICAL JOURNAL
The average total dose of gold was 1.250 grams
and given in this manner : for the first six weeks the
patient received 25 mgms. of gold thioglucose every
four days. It was during this period that the re-
actions to gold were the most frequent. At the end
of this period 25 mgms. were given once weekly for
six weeks; then 25 mgms. were given every two
weeks for six doses. At this time the same doses
were continued once every three weeks for six
doses, and then once a month up to a period of two
years from the beginning of therapy.
Up to the present time, after a ten-year period,
we have seen but three relapses out of our total of
thirty-six cases treated under this program. All
three of these cases had had their therapy inter-
rupted for a period of one year or more due to
various domestic reasons.
One can readily appreciate the necessity of hav-
ing the patient adhere rigidly to the program out-
lined to him beforehand.
The schedule last outlined, is developed more or
less according to the precepts of Hartung, and in
our hands has proven highly satisfactory thus far.
D. Selection of Cases and Diagnosis
The selection of cases suitable for gold therapy
is an extremely important consideration and one
about which there should be little or no debate. It
postulates one’s familiarity with the metabolism
and pharmacology of gold and the nature of the
disease to be treated.
First of all, one should be convinced clinically
that the disease is that of rheumatoid activity, and
secondly, one should explain to the patient that gold
contributes only insofar as it arrests the disease
but does not repair the damage done to cartilage
and bones, nor does it restore deformed and anky-
losed joints. It is also important, insofar as the
patient and his financial economy are concerned,
that one does not subject a patient suspected of
rheumatoid activity to a course of three years of
therapy uselessly, with all its attendant therapeutic
complications.
The ideal objective in the treatment of patients
with rheumatoid arthritis is to prevent crippling
deformities and incapacitations and to have him
restored as much as is possible, to complete rehabili-
tation. To wait until the gold treatment be used as
a last resort is only fostering poor and unimpressive
results, since joint damage has already taken place
and the destructive changes already present cannot
be remedied.
Proper use of gold salts in the early stages ol
rheumatoid arthritis with active synovitis produces
gratifying results. It has been found by many
workers that in the symptom-free group treated
with gold most were treated within one year of
onset of the disease.
RHEUMATOID ARTHRITIS
It has been the opinion among many rheumatolo-
gists, however, that one should observe early cases
during the first three months, not instituting gold
therapy at the onset, but evaluating the progress of
the disease at monthly intervals and resorting to
physical therapy, intra-articular injections of Hy-
drocortisone acetate and active exercise. If gratify-
ing results are obtained, then gold therapy is held
in abeyance until such time as the disease seems to
be advancing in spite of these measures last men-
tioned.
In choosing the specific cases for gold therapy
certain criteria have been helpful:
1)X-ray findings are generally disappointing
and one should not rely too much on this examina-
tion. However, punched-out areas of bone destruc-
tion in the subchondrial areas are significant espe-
cially if it is co-ordinated with the patient’s history
and clinical findings. Usually one finds these areas
of decalcification or bone destruction in the meta-
tarso-phalyngeal joints of the feet as the first mani-
festations. These appear under the big toe first
since this is the point of greatest trauma.
2) The sedimentation rate is elevated in about
90% of the cases. However, in the remaining
10% where there is no elevation of the sedi-
mentation rate one must rely upon one’s clinical
acumen and the other laboratory tests to give one
the clue.
3) ‘Protein Metabolism—many workers such as
Wallis, Salt and Olhagen have found that in most
cases of rheumatoid activity there is a tendency
towards a reversal of the A-G ratio, a drop in the
total serum protein level, an increase in the plasma
fibrinogen, and a positive thymol turbidity test.
4) Agglutination of Sensitized Sheep Cells—
apparently it is now well established that the serum
of (more than half) of the rheumatoid patients
will increase the specific agglutination of cellular
antigens. In the work done by Ziff, Brown, Badin
and McEwen, 92% of the patients with adult rheu-
matoid arthritis gave a positive test.
5) Lately it has been suggested that, in addition
to emploving the usual erythrocyte sedimentation
rate, as a measure of rheumatoid activity, one resort
toa method which has been found to be more re-
liable and more stable: The serum polysaccharide-
protein ratio. The polysaccharide-protein ratio is
obtained by dividing the polysaccharide concentra-
tion by the serum protein and multiplying the result
by 100. An elevated serum polysaccharide-protein
ratio occurs, apparently, in active rheumatoid arth-
ritis and other collagen diseases. It can be utilized
as a nieasure of the degree of clinical activity.
An increased clinical activity of the disease is
accompanied by a proportionate rise in the poly-
saccharide-protein ratio, while a remission is at-
tended’ by a fall in the ratio. This ratio remains
625
constant in the normal individual and undergoes
only slight change in minor infections or trauma.
Although inflammatory states, neoplastic diseases
and severe trauma seem to affect this ratio, they
are seldom of a severity sufficient to bring about
an alteration in it.
E. Effect of Gold in Applicable Cases
In cases of rheumatoid activity where conserva-
tive therapy has not produced gratifying results
within the first three months, and gold treatment is
instituted at this time, one finds in the majority of
cases an almost immediate response.
Following are the statistics on the thirty-six pa-
tients treated by us during the past fifteen years.
They have been graded according to time in which
loss of pain and oedema, return of mobility and
complete rehabilitation took place after therapy.
Months 1 a 3 4 6 8 12 24
Loss of
Pain
Loss of
Oedema
Return of
Complete
Mobility
Complete
Rehabilitation
36% 48% 02% 02% 02%
41% 50% 11%
25% 33% 02% 30% 8%
22% 25% 8% WN% 02% 05% 13%
One patient had loss of pain after the first injec-
tion. This was a case of acute rheumatoid activity
of three months’ duration. Another patient had
loss of pain only after one entire year of treatment.
This person was an extremely hyperexcitable in-
dividual who suffered more muscle spasms than
actual articular pain.
Before the twelfth week of gold therapy the ma-
jority of the patients were able to state that no
longer were they susceptible to barometric pressure
changes which had heretofore always heralded an
onslaught of polyarticular pain and synovial sensi-
tivity. This refractoriness to barometric pressure
changes has been used as a criterion, in this office,
for future steady improvement.
Practically all patients, once having gone beyond
this hurdle, complain very little even after perform-
ing their usual routine, daily occupations.
We must mention that the entire period of gold
administration was constantly accompanied by
physical therapy and active exercises. This latter
consideration is all important in the objective of
complete rehabilitation of the patient.
F. Gold vs. Other Drugs
1. Cortisone and ACTH. Though Cortisone and
ACTH have been effective in their anti-rheumatic
activity, they have not been without their serious
drawbacks and consequences. In addition to the
continued on next page
626
fact that rheumatoid cases would have to be placed
under perpetual Cortisone therapy in order to avoid
relapses, in which case the cost is staggering to the
patient, the side reactions of these hormones under
long-term therapy is well known.
The results produced upon withdrawal of the
steroids have been studied by such workers as Ball
of the Rheumatism Research Centre at the Uni-
versity of Manchester, England, and Slocum of the
Mayo Clinic. They have shown that there exists a
panmesenchymal and panangiitic reaction that car-
ries all the risks of polyarteritis nodosa or of acute
lupus erythematosis. The effects of these hormones
are temporary and suppressive but not curative.
The intra-articular injections of a steroid such
as Hydrocortisone Acetate in repeated injections
offer a fairly consistent, long-lasting palliation but
only time will tell whether the alleviating effect of
this drug will result in long range benefits to the
patient.
2. Copper. The use of copper salts such as Cup-
ralene was introduced in 1949 by the Father of gold
therapy, Jacques Forestier, of Aix-les-Baines,
France. He advocated its use during the subacute
stage of rheumatoid activity and claimed that they
gave better results than gold salts in these cases.
Work done in the United States with this therapy
did not bear out his contentions, however.
3. Butazolidin or Phenylbutazone. In rheuma-
toid spondylitis Butazolidin is the drug of choice
and the results have been found to be superior to
either Cortisone, ACTH or X-ray therapy. How-
ever, the prolonged administration of the drug is
accompanied by a great deal of danger toward
agranulocytosis and must be given with the utmost
care.
Like Cortisone and ACTH, Butazolidin does not
arrest the disease but gives only temporary pallia-
tion.
G. Gold Toxicity. Toxicity from gold adminis-
tration may manifest itself at any time after the
initial injection. In our experience most of the
manifestations of gold toxicity showed themselves
within the first six weeks of therapy, the most fre-
quent being skin rashes on the nature of an eczema-
toid dermatitis. Frequently one encountered pa-
tients who complained of a generalized pruritis
without any evidences of a skin irritation.
Other manifestations of toxicity were: nausea,
abdominal cramps and occasionally diarrhea, head-
ache, sub-sternal oppression, vertigo and a metallic
taste in the mouth. In one case there was a flare-up
of giant hives or angio-neurotic oedema.
None of these evidences of toxicity was consid-
ered as a contra-indication to further gold therapy.
After a resting period of three to four weeks, when
all symptoms had disappeared, gold injections were
resumed.
RHODE ISLAND MEDICAL JOURNAL
At no time, in our fifteen years of experience
with Chrysotherapy, did we encounter a case of
exfoliative dermatitis or agranulocytopenia due to
bone marrew inhibition. Extreme caution upon the
first manifestation of skin reactions perhaps helped
to avoid the former danger, and the use of purified
liver extract, 10 megr. per c.c., given with each gold
injection perhaps helped to avoid the latter.
As it has been mentioned by Freyberg, there are
many indications that gold toxicity in human be-
ings is an allergic type of reaction. The fact that
there is an occurrence of dermatitis of an eczema-
toid form after only one, two or three injections;
the frequent occurrence of esinophylia preceding
and during the toxicity ; that some times there is a
development of toxicity following a single, small
injection of gold given after an interval of many
weeks following completion of a course of gold that
was well tolerated; all these point to an allergic
concept.
It has been significant in our experience that
those patients who were found to have an allergic
substratum, either in the form of an allergic rhini-
tis, frank bronchial asthma, gastro-intestinal al-
lergy or allergic dermatitis, were precisely those
who manifested a gold toxicity. In all these cases
the administration of Cortisone, either parenterally
or orally, for three to four days subsequent to their
injection of gold warded off all signs of toxicity,
that had manifested themselves on previous in-
jections.
Experience has shown that many conditions
formerly thought to be contra-indications to gold
actually are not. Allergic diseases no longer pre-
vent the use of gold therapy since the concomitant
administration of Cortisone can mitigate the toxic
reactions.
Pregnancy is not necessarily a contra-indication,
since many pregnant patients have tolerated the
therapy well and with no untoward reactions to the
child. Rheumatoid patients, however, are bene-
fited by pregnancy and gold therapy is seldom de-
sired throughout this period.
Serious kidney or liver disease with functional
impairment of these organs, blood dyscrasias,
hemophilia and severe anemia are considered to be
definite contra-indications to gold therapy.
When gold therapy is beneficial, in the well-done
cases, it is most gratifying to note the signs of in-
flammation decreasing, the gradual and progressive
lessening of pain and the improvement in articular
functioning. Thus far, gold is the only drug at our
command that produces an arrest of the rheumatoid
activity when employed in a well-planned program
of treatment. After twenty-five years of use It
remains as our only effective agent, and the avail-
ability of Cortisone and ACTH have helped us to
reduce further the risks of toxic reactions.
concluded on page 629
MEDICAL ADVISORY COMMITTEE AND THE DISABILITY FREEZE
TYTYVUVVUVVUYVITVUYVIVVUUVYYYYVVYVOTIUVY VOU VUPUVIECTUYVUCTUNVUVULIOETIOUVIVIGIYOT
THE MEDICAL ADVISORY COMMITTEE AND THE
DISABILITY FREEZE
CHARLES L. FARRELL, M.D.
The Author. Charles L. Farrell, M.D., of Pawtucket,
Rhode Island. Member, Medical Advisory Committee
to the Social Security Administration; President, Con-
ference of Presidents and Other Officers of State Med-
ical Associations; President-elect, Rhode Island Med-
ical Society.
vai Fepruary, a Medical Advisory Committee
was appointed to advise. the Social Security
Administration in connection with medical policies
involved in the new “disability freeze” provision.
Medical practitioners may be interested in learning
about the composition and activities of the Com-
mittee and of the operations of the “freeze” pro-
vision since many of their patients undoubtedly
have rights under this provision.
The disability freeze provision permits a quali-
fied individual to maintain his old-age and survivors
insurance rights during extended periods when he
is totally disabled by reason of a medically deter-
minable physical or mental impairement.' For the
long run, the determinations of disability will be
made mostly by the vocational rehabilitation agency
or by another appropriate agency in the applicant’s
own state, under agreements negotiated between
the states and the Secretary of Health, Education,
and Welfare. The Bureau of Old-Age and Surviv-
ors Insurance is responsible for making determina-
tions in cases not covered by State agreements.
Determinations of disability are made with a
“team” approach—i.e., by a physician and a quali-
fied counselor or lay person skilled in evaluating the
effect of impairments on ability to work. In many
States the physician member of the “review team”
is in private practice and serves as a consultant to
the State agency for purposes of making freeze
decisions. The role of the attending or examining
physician in submitting the medical report is of
paramount importance to the program, for it is on
_ |For an individual to become entitled to monthly old-age
Msurance (i.e., retirement) payments or for his family to
become entitled to monthly payments in case of his death,
he must meet a minimum work requirement under social
security. The amount of his payments is then calculated
from his average monthly earnings in work covered by
social security. The new law preserves a disabled worker’s
rights ad permits his period of disability to be excluded in
determi:|ing the amount of his benefit.
the basis of the clinical findings and other medical
evidence in the report that a determination of the
severity of the impairment is made. By submitting
accurate, specific reports, the physician can render
assistance to the applicant and at the same time
facilitate fair and proper disposition of the claim.
The Purposes of the Medical Advisory Committee
In agreeing to serve on the Medical Advisory
Committee, the members of the Committee affirmed
their understanding that the disability freeze defi-
nitely does not include nor contemplate cash pay-
ments before age 65, nor any type of State or gov-
ernmental treatment other than that now existing
or available to the States under present laws.
Briefly, the purposes of the Medical Advisory
Committee are:
1. To provide technical advice and consultation
regarding medical aspects of the administra-
tion of the freeze provision.
. To promote mutual understanding and effec-
tive working relationships among the Social
Security Administration, cooperating State
agencies, and physicians generally.
. To provide professional guidance in formulat-
ing medical guides and standards for evaluat-
ing disability.
Composition of the Committee
The membership of the Committee represents a
wide variety of skills in medical practice and public
and private medical and welfare administration.
The Social Security Administration and the State
agencies administering the freeze provision would
thus have the benefit of diverse professional ex-
perience. Among the professional and industrial
groups represented on the Committee are general
medical practice, internal medicine, physicial medi-
cine, preventive medicine, ophthalmology, surgery,
vocational rehabilitation, orthopedics, public health,
labor unions, and social welfare agencies.” Insofar
as possible the major geographical sections of the
country are represented, also.
Accomplishment of the Committee
The Committee met with representatives of the
Department of Health, Education, and Welfare in
Washington in February, March, and May, 1955.
continued on next page
628
A report of its recommendations to date has been
submitted and recently published.* Additional
meetings will be held in the future.
One of the problems considered by the Com-
mittte relates to the responsibility placed on the
applicant by law to furnish proof of his disability.
To carry out this provision, the Committee found
it reasonable for the Bureau of Old-Age and Sur-
vivors Insurance to advise the applicant to secure a
current medical report from his own physician or
from another medical source, hospital, clinic, or
agency, based upon an existing medical record or
upon a current examination. This report, if it is
complete and factual, will ordinarily be sufficient to
establish the degree of severity of the applicant's
disability. In some cases there will be need for
additional medical information, and occasionally,
an additional examination. The “review team” may
need additional reports of diagnoses and clinical
findings from existing records, and will advise the
applicant that he must secure these.
Where the initial medical report submitted by an
applicant's physician fails to establish the severity
of the impairment, the physician in the administer-
ing agency may write directly to the applicant’s
physician for additional data. It is believed that this
approach will preserve and strengthen the doctor-
patient relationship. If the necessary information
cannot be provided by the attending physician with-
out a further examination, the applicant will need
to be informed and must be responsible for any fee
charges, since it is part of the applicant's own re-
sponsibility to prove his disability. A medical ex-
amination at the expense of the Government may
be authorized only in the exceptional case where, in
the judgment of the review physician, it seems nec-
essary to verify facts to insure that an improper
award will not be made.
The Committee also considered operating in-
structions to be issued to State agencies and the
medical criteria for evaluation of specific impair-
ments and combinations of impairments. These
proposed guides and standards were reviewed and
analyzed by sub-groups of Committee members
with specialized training and experience in the par-
ticular subject matter under study. The sub-groups
made a number of suggestions to clarify the mate-
rial and bring it into conformity with most recent
developments in medical science. The Committee
approved the use of the medical guides as an initial
basis for operations during the coming months.
2The Committee appointed by the Social Security Ad-
ministration in the U. S. Department of Health, Education,
and Welfare consisted of the following members: See list
on page 629.
3Medical Advisory Committee Report and Recommenda-
tions on the Administration of the OAST Disability Freeze
Provision—copies for sale by the Superintendent of Docu-
ments, Government Printing Office, Washington 25, D.C.,
at 10 cents per copy or 100 copies for $7.50.
RHODE ISLAND MEDICAL JOURNAL
These criteria establish a test of severity which an
applicant’s impairment must meet in order for him
to qualify for the freeze.
How the Attending or Examining Physician
Can Help
The Committee feels that practicing physicians
should have a real understanding of the freeze pro-
vision since many of their patients will be asking
them for medical reports to be submitted to the
appropriate agency in their State to establish their
disabilities. Ordinarily a person so severely dis-
abled as to qualify for a freeze will be under the
medical care of a physician or will have had a medi-
cal examination for his condition.
Medical reports are normally submitted directly
to the Social Security Administration for transmit-
tal (together with the application and other papers)
to the State agency making the disability determina-
tion, rather than through the applicant. The report
form calls for pertinent history, clinical findings
and diagnosis. It is purposely short and simple,
intended to be flexible. Use of any other form, or
a narrative statement is acceptable, so long as the
information contains the necessary facts relating to
pertinent history, symptomatology, clinical findings
and diagnosis. Because various State and Federal
disability provisions established by law operate
under legally defined concepts of disability, defini-
tions among programs differ. Reporting physicians
are not asked to decide whether the applicant is
under a disability. Their responsibility, instead, is
to give the agency medical facts and findings suf-
ficient for its physician to reach a conclusion as to
diagnosis and the severity of the impairment, and
therefore determine whether the applicant meets
the definition of disability for this program.
Experience to date with the medical report form
has been generally good, but some of the reports
received contain insufficient medical findings to per-
mit a reviewing physician to evaluate the extent
and degree of the impairment. In such case, it is
necessary to ask the reporting physician to describe
more precisely his findings. Consideration was
given by the Medical Advisory Committee to re-
vising the present form to call for more detailed
information. However, it was agreed at the May
meeting that the present medical report form could
be used until more experience indicated the kind of
revision necessary. Comments from practicing
physicians are welcome. Their opinions are highly
regarded and carefully considered.
SUMMARY
In February, the Commissioner of Social Secur-
ity appointed a Medical Advisory Committec repre-
sentative of different specialties, including general
practice, and different geographical portions of the
1955
country to advise him with respect to the medical
policies involved in administration of the new dis-
ability freeze provision. The Committee has met,
considered and approved for the early months of
operation, proposed guides and standards fixing the
responsibility for obtaining evidence of disability
and the type and amount of evidence required to
establish disability. Since the applicant has the re-
sponsibility of presenting proof of disability, he
will need the cooperation of his attending physician.
The latter should furnish the administering agency
with a current report of medical findings sufficient
to permit a decision to be made as to the severity of
the impairment and whether the applicant is
“disabled” as defined by law.
NOVEMBER,
MEDICAL ADVISORY COMMITTEE ON
DISABILITY FREEZE
Dr. J. DUFFY HANCOCK, Chairman. President of
the Southeastern Surgical Congress and Clinical
Professor of Surgery at the University of Louis-
ville School of Medicine. Louisville, Kentucky
Miss PEARL BIERMAN. Medical Care Consultant,
American Public Welfare Association. Chicago,
Illinois
Dr. PHILIP D. BONNET.
chusetts Memorial Hospital.
setts
Dr. DONALD CovALT. Associate Professor, De-
partment of Physical Medicine and Rehabilita-
tion, New York University College of Medicine.
New York, New York
Dr. CHARLES L. FARRELL. President of the Con-
ference of Presidents and Other Officers of State
Medical Associations; President-elect, Rhode
Island Medical Society. Pawtucket, Rhode Island
Dr. J. S. FELTON. Associate Professor, Department
of Medicine and Department of Preventive Medi-
cine, University of Oklahoma. Oklahoma City,
Oklahoma
Dr. HERMAN E. HILLEBOE. Commissioner, State
Department of Health. Albany, New York
Dr. LEMUEL C. MCGEE. Medical Director, Her-
cules Powder Company. Wilmington, Delaware
Dr. KENNETH E. MCINTYRE. Director, Metropoli-
tan Hospital, cooperating arrangements, United
Automobile Workers CIO. Detroit, Michigan
Dr. WILLIAM A. PETTIT. State Supervising Oph-
thalmologist for the California Department of
Public Welfare. Los Angeles, California
Dr. LEO PRICE. Director, Union Health Center,
International Ladies’ Garment Workers’ Union.
New York, New York
Dr. WILLIAM HAROLD SCOINS. Chief Medical Di-
rector, Lincoln National Life Insurance Com-
pany. Fort Wayne 1, Indiana
CARROLL SHARTLE, PH.D. Professor of Psychology
and Executive Director of the Personnel Re-
search Board, Ohio State University. Columbus,
Ohio
MR. BYRON SMITH. Executive Secretary, Minne-
apolis Society for the Blind. Minneapolis,
Minnesota
Dr. Davin WADE. Medical Consultant for the
Texas Division of Vocational Rehabilitation.
Austin, Texas
Administrator, Massa-
Boston, Massachu-
629
RHEUMATOID ARTHRITIS
concluded from page 626
It is true that it is by no means an ideal drug, and
improvements in treatment for rheumatoid arthritis
may develop in such a trend as to eliminate the need
for gold therapy. At that time all those engaged in
chrysotherapy will be the first and the happiest to
abandon it in favor of superior treatment.
REFERENCES
C. D. Kersley, L. Mandel and M. R. Jeffrey : Gold, Sodium
and Liver Function in Rheumatoid Arthritis. Annals of the
Rheumatic Diseases—12 :29, March 1953
J. Forestier : Copper and Gold Salts in Rheumatoid Arthri-
tis. Annals of Rheumatic Diseases—8 :132, June 1949
N. Egelius, N. G. Havermark and G. Nystrom: Late Re-
sults of Gold Treatment in Rheumatoid Arthritis. Annals
of the Rheumatic Diseases—11 :17, March 1952
John Ball : Rheumatoid Arthritis and Polyarthritis Nodosa.
Annals of the Rheumatic Diseases—13 :277, Dec. 1954
Lennart Kalliomaki: Correlation of the Erythrocyte Sedi-
mentation Rate and Gold Complications’ in Rheumatoid
Arthritis. Annals of the Rheumatic Diseases—13 :336,
Dec. 1954
Tore Svanberg: Experiments in Gold—Testing in Gold
Treatment of Polyarthritis. Annals of the Rheumatic Dis-
eases—9 :221, Sept. 1950
Gunnar Edstrom: The Effects of 2,3 Dimercapto-Propanol
(BAL) on Gold Reactions. Annals of the Rheumatic
Diseases-—9 :109, June 1950
Edward Boland and Nathan E. Headley: Treatment of
So-Called Palidromic Rheumatism with Gold Compounds.
Annals of the Rheumatic Diseases—8 :64, March 1949
James Bruce and Robert Mackay : Gold Therapy and Neu-
tral 17—Ketosteroid Excretion in Rheumatoid Arthritis.
Annals of the Rheumatic Diseases—11 :206, Sept. 1952
Morris Ziff, Patricia Brown, Jacques Badin and Currier
McEwen: A Hemoagglutination Test for Rheumatoid
Arthritis with Enhanced Sensitivity using the Englobulin
Fraction. Bulletin on Rheumatoid Diseases, Vol. V, No. 2,
Oct. 1954
R. W. Payne, M. R. Shettar, Jane Bullock, D. R. Patrick,
A. A. Hellbaum and W. K. Ishmael: The Serum Poly-
saccharide—Protein Ratio as a Measure of Rheumatoid
Athritis Activity. Annals of Internal Medicine, Vol. 41,
No. 4, Oct. 1954
Richard Freyberg: The use of Cortisone and ACTH in
Rheumatoid Arthritis. Bulletin on Rheumatic Diseases,
Vol. I, No. 1, Sept. 1950
Hollander and Collaborators: Arthritis and Allied Condi-
tions. 5th Edition, Lea and Febiger, 1953
“From ancient Epsom Salt to
modern Prednisolone”
Defy Mg Druggisd
Fills Prescriptions
Plainfield St. at Laurel Hill Ave.,
Providence, R. I. TEmple 1-9649
RHODE
ISLAND MEDICAL JOURNAL
PHLEBITIS*
JOHN J. BYRNE, M.D.
The Author. John J. Byrne, M.D., Director, Third
(Boston University) Surgical Service, Boston City
Hospital; Associate Professor of Surgery, Boston
University School of Medicine.
At the Reunion Day of St. Joseph’s Hospital Staff Asso-
ciation on September 7, 1955, Dr. John J. Byrne was one
of the group that gave a symposium on “Peripheral Vas-
cular Disease.” His talk on “Thrombophlebitis” was a
most interesting one and he backed it up with a large
number of excellent statistics. Statistics are valuable, but
they do not make especially lively reading, and as the
aforesaid statistics have been given elsewhere, we asked
him if he would not write us an article giving his views
and allowing us to certify the excellence of the statistics.
He promised to do this and we are greatly pleased to
present at this time his ideas on phlebitis.
THE EDITOR
i iene 1s much confusion about the best treat-
ment of phlebitis. The most important reason
for this is the lack of knowledge of the basic cause
of the disease. Until we can find the essential factor
that produces phlebitis, we will be at our wits’ end
in treating it.
We know there are three general factors capable
of initiating thrombosis: damage to vein intima,
stasis of the circulation, and increased coagulability
of the blood. The intima of the vein may be altered
by trauma, infection, chemical agents, and even
hypoxia. Processes which may produce circulatory
stasis are heart disease, varicose veins, pregnancy,
hemiplegia, bed rest, tight abdominal binders, obe-
sity, shock, and diminished respiratory ventilation.
Changes in the coagulability of the blood are known
to be associated with the postoperative period, blood
dyscrasias (polycythemia vera), neoplasm, infec-
tion, and dehydration.
Although we do not know the cause of phlebitis,
we are certain of the diseases which predispose to
it. A recent study of a large series of patients at the
Boston City Hospital revealed the following dis-
eases to be associated with phlebitis in this order of
frequency: cardiac disease, postoperative state,
trauma, infection, varicose veins, pregnancy, hemi-
plegia, cancer, and a small idiopathic group.’
Besides being the most frequent primary disease
associated with phlebitis, cardiac disease is an asso-
*Presented at the Reunion Day of the St. Joseph’s Hospital
Staff Association, Providence, Rhode Island, September
7, 1955.
ciated factor in most of the other cases. Not only
are cardiac patients more predisposed to phlebitis,
but they are less able to withstand the embolism
which may occur. Approximately 73 per cent of
the fatal pulmonary emboli were associated with
heart disease.
The hemiplegic cases require special note, since
most of the fatal pulmonary emboli were unsus-
pected. The majority of the hemiplegic cases were
either holding their own or improving when they
died of the pulmonary embolism. This is mentioned
solely to deter a pessimistic attitude toward the
hemiplegic. A large percentage of these people will
go on living many fruitful years. Whenever a physi-
cian treating a hemiplegic patient discovers that the
paralyzed leg becomes swollen or exhibits varicose
veins or other signs of the phlebitic syndrome, he
should actively treat this disease to prevent em-
bolism.
Migratory phlebitis was seen in a few of the
cancer patients in this series. We are well aware of
the association of this disease with Buerger’s dis-
ease. Too often, its association with carcinoma is
not thought of.
In order to prevent phlebitis various measures
must be taken to combat some of the factors men-
tioned in the second paragraph. The most useful
measures are compression bandages on the legs,
continuous ambulation, and elevation of the legs of
bedridden patients. Continuous ambulation should
be emphasized in surgical patients because too often
a patient is bedridden before surgery and then is
immediately ambulated the day after surgery. Pre-
operative as well as postoperative ambulation
should be the rule.
Despite all prophylactic measures phlebitis, with
its attendant pulmonary embolism, will occur. I
firmly believe that the best prevention against pul-
monary embolism is the early diagnosis and prompt
treatment of phlebitis. The lower extremities of all
patients confined to a hospital should be checked
daily by the physician in order to elicit any calf dis-
comfort or any other evidence of phlebitis. Phys'-
cal examination may elicit any of the following
signs : calf tenderness, edema, tenderness along the
popliteal or femoral veins, positive Homans sign,
distended veins in the involved extremity, arterial
spasm, or cyanosis. The presence of superficial
phlebitis in any patient, particularly the elderly,
PHLEBITIS
should always arouse a suspicion of an underlying
deep phlebitis.
The nursing staff should also be alerted to the
possibility of phlebitis and should aid in the detec-
tion of this disease. The nurses are more closely
associated with the patient than the physician. They
see them hourly on the wards and are more apt to
be informed of any slight calf discomfort than is
the physician. Physicians teaching nurses should
emphasize this particular point.
As soon as the diagnosis is made, phlebitis should
he treated by whatever measure the physician con-
siders of value. One should never wait for a pul-
monary embolism to occur before treatment, since
at the Boston City Hospital the first embolus was
fatal in over 80 per cent of the cases.
There is much discussion as to whether phlebo-
thrombosis and thrombophlebitis are separate proc-
esses. It is often thought that phlebothrombosis
with minimal signs has a high rate of pulmonary
embolism, and that thrombophlebitis with its more
obvious pain, tenderness, and edema is associated
with a low rate of pulmonary embolism. This often
lulls a physician into a false sense of security when
treating so-called thrombophlebitis. At the Boston
City Hospital there was such a high rate of em-
bolism with the two processes that both should be
treated as actively as possible.
Today, there are two ways of preventing pul-
monary embolism in phlebitic patients : the adminis-
tration of anticoagulants or proximal venous inter-
ruption. Anticoagulant therapy consists of pre-
scribing heparin for the first several days until
Dicumarol or Danilone are giving satisfactory
blood levels. The clotting time for heparin therapy
should be approximately thirty minutes, and a
prothrombin time of thirty to forty seconds should
be maintained with Dicumarol or Danilone.
The usual contra-indications to anticoagulant
therapy are failure of such therapy to prevent em-
boli, recent postoperative cases, cerebral hemor-
rhage, recent post-partum cases, hepatic or renal
disease, bleeding diatheses, subacute bacterial endo-
carditis, and large ulcerating areas. In addition to
these contra-indications there are definite theoreti-
cal disadvantages to anticoagulant therapy. In the
first place, one cannot get as quick a protection as
with surgical division. Several of our patients died
within twenty-four hours of admission before
proper blood levels could be obtained. Secondly,
it is a well-known fact that in spite of adequate
prothrombin or clotting time levels, fatal emboli
have occurred. Thirdly, one is never sure when to
stop inticoagulant therapy. Several of our fatal
cases occurred after the anticoagulant therapy had
been mitted.
There are definite hemorrhagic complications of
antic agulant therapy. Sloughing areas associated
631
with hematomas are time-consuming and add weeks
or months to a patient’s hospitalization. Some of
the hemorrhages have been fatal.
The mortality rate for a small series of cases
treated with anticoagulant therapy at the Boston
City Hospital was 29 per cent as compared to a
mortality rate with no treatment of 37 per cent in
a larger series of cases
In contra-distinction to the above-mentioned high
mortality rates, surgical treatment demonstrated a
rate of only 2.1 per cent. Although surgery gave
by far the best results in preventing emboli, some
failures occurred. By analyzing these as well as
reviewing the successful experiences, the following
scheme of treatment has evolved:
Surgical division of the superficial femoral veins
should be done when the phlebitis is confined to the
calf veins. Division, rather than ligation, is em-
phasized since we have had cases which have re-
canalized and thrown off fatal emboli after ligation.
Following the femoral division compression ban-
dages should be applied to the legs, and the patient
should be ambulated as soon as possible. Following
bilateral superficial femoral division, if signs of
phlebitis occur proximal to the division, vena cava
division or anticoagulant therapy is needed. The
choice will depend upon the condition of the patient.
A division of the common femoral vein should be
performed if there is evidence that phlebitis is
present in the thigh veins. Signs of this would be
tenderness along the femoral veins, edema in the
thigh, obvious disease in the deep femoral system at
the time of surgery, or in phlebitis accompanying
fractured femurs when it can be assumed that there
is disease in the thigh veins. These cases should
have Ace bandages and early ambulation following
surgery. The possibility of the phlebitis spreading
proximally should be carefully noted so that further
therapy can be instituted.
During division of either the superficial or
common femoral veins, if the blood clot cannot be
easily removed to give a strong retrograde flow of
blood, either a vena cava division or anticoagulant
therapy is indicated. The chief consideration here
is the physical condition of the patient, since a vena
cava ligation is a serious operation and should not
be contemplated on patients who are poor risks.
When phlebitis is obviously in the iliac or other
pelvic veins, cava division or anticoagulation is nec-
essary. There is one difference, however, in that
bilateral ovarian vein division should accompany
the vena cava ligation in women.
What is the best treatment after a pulmonary
embolism has occurred? Essentially, it will depend
upon the site of the phlebitis. However, the size of
the embolus may be a deciding point, particularly if
vena cava division is under consideration. With
serious clinical or X-ray signs of pulmonary em-
concluded on page 661
632
RHODE
ISLAND MEDICAL JOURNAL
[224268296629 6688 6 9S 0 SEES C59 FESS ESe SETS ESEEE EEE LESSEE AC eS APsAe CLIPPER Eee se.
THE BEGINNINGS OF MEDICAL EDUCATION IN RHODE ISLAND
Part III
SEEBERT J. GOLDOWSKY, M.D.
(concluded from October, 1955, volume XXXVIII, number 10, page 593)
The Author. Seebert J. Goldowsky, M.D., Surgeon,
Miriam Hospital; Assistant Surgeon, Rhode Island
Hospital, Providence, Rhode Island.
_ THE CLOSING Of Brown University Medi-
cal School the first two centuries had almost
come to a close. The beginning of the modern era
hegan some forty years later with the opening of
Rhode Island Hospital. We shall retrace our steps
with a quick survey of the growth and development
of hospital practice in the state, culminating in that
important event. The earliest hospitals were of
three general categories: military ; marine, for the
care of sick merchant seamen; and quarantine, for
isolating patients with such diseases as smallpox
and yellow fever. There appears to have been an
overlapping of functions in the latter two types.
The buildings provided were usually of modest
proportions and were frequently merely private
homes requisitioned for hospital purposes. New-
port established a smallpox hospital on Coaster’s
Harbor Island in 1716, while Bristol procured a
house for the same purpose as early as 1732. In
1792 an older quarantine building in Newport was
rejuvenated as a smallpox hospital.
During 1777 a military general hospital was
established at Tiverton for the handling of casual-
ties expected in the local operation against the
British, known in history as the Battle of Rhode
Island. In 1789 a United States Marine Hospital
was established at Newport, but this had a brief
career, having been discontinued before 1802, ac-
cording to official government reports. There is
some evidence, however, that this facility operated
much longer, inasmuch as Doctor David King of
Newport wrote in 1859 that Doctor Edmund
Thomas Waring served for some thirty years as
“Physician of the United States Marine Hospital
... thus occupying a post which the extensive com-
merce of Newport rendered both lucrative and
important.”
Early Providence Hospitals
Between 1752 and 1776 the Town of Providence
provided three smallpox hospitals, the first two be-
ing in North Providence and at Tockwotton. The
third, built in 1776, was in the general vicinity of
the present city yards on Henderson Street. In
1798 at the height of the yellow fever epidemic of
that year, the town built a new hospital on the west
side of the river near the site of the one last men-
tioned, for the reception of patients with that dis-
ease. A bill for labor and materials still extant
among the old town papers designates this building
bhai
Ky ui
ear.
Fig. 7. The “New Hospital,” also referred to as the
Marine Hospital, before removal to its present site on the
grounds of the Rhode Island Hospital, where it is pres-
ently used as the employment office. (Reproduced from
Fields “State of Rhode Island and Providence Planta-
tions,” 1902)
as the “new hospital,”’ and maps subsequent to this
period for the next two or three decades designated
these buildings as the “old hospital” and the “new
hospital.” Just when the latter acquired the desig-
nation of the “Marine Hospital” is not clear. At
any rate it is important to us so identified as it still
stands and provides a link with the past. It stood
originally on the present location of the old Rhode
Island Hospital (soon to be torn down). Upon the
building of that structure it was moved to its pres-
ent site near the Lockwood Street entrance and
still serves as the employment office. The porch was
not part of the original edifice. We have noted
earlier that Doctor Levi Wheaton served it as phy-
sician for many years and probably used the clinical
material for teaching purposes. In 1900 on the
occasion of the opening of a new pavilion at the
Rhode Island Hospital, Doctor J. W. C. lly, the
only surviving member of the original stait, pro-
BEGINNINGS OF MEDICAL EDUCATION
vided the following reminiscence: “On it stood a
long, low two story building, used by the city for
contagious diseases, especially ship fever and small-
pox. During the fifteen and one half years of serv-
ice as city physician, | gained most of what clinical
knowledge I have of small-pox and typhus fever in
that building.” It was last used for patients during
the Civil War. In the summer of 1862 Governor
Sprague requisitioned it to provide shelter and food
for invalid and wounded soldiers passing through
Providence on their way home to other states. It
was closed after one year, having received during
its period of operation 750 casualties, ‘embracing
many wasting away under disease engendered by
the exposure of the field, or suffering severely from
wounds.”
We have noted earlier that the city acquired
property at Field’s Point in 1824 for the establish-
ment of a smallpox hospital. A sentinel was kept
on the Point to flag down ships for quarantine pur-
poses, as provided in town quarantine regulations.
This facility was maintained on a stand-by basis,
although rarely used, until the Providence City
Hospital for contagious diseases, later the Charles
V. Chapin Hospital, was opened in 1909. A photo-
graph of the old building published in 1902 revealed
it to be hardly more than a hut.
Fig. 8. The Smallpox Hospital at Field’s Point. (Repro-
duced from Fields “State of Rhode Island and Providence
Plantations,” 1902)
In 1829, one year after the building of the Arcade
and the opening of the ill-fated Blackstone Canal,
the benefactors of the community incorporated the
Providence Dispensary to provide medical care and
medicines to the indigent residents of the city ona
home care basis. The dispensary had no beds. It
disappeared from the scene around the turn of the
century,
Mrs. Anne Royal of the City of Washington,
writing in her “Sketches of History, Life and Man-
ners in the United States,’ made the following
observations about Providence in 1826: “Provi-
dence is a very romantic town, lying partly on two
hills «nd partly on a narrow plain, about wide
enoug!) for two streets. .. . It contains 14 houses
IN RHODE ISLAND— PART III
633
for public worship, a college, a jail, a theater, a
market-house, 8 banks, an alms-house, part of
which is a hospital, and 12,800 inhabitants [a fairly
accurate estimate]. The churches are very splen-
did, and the jail is tolerable, but the poor-house does
not deserve the name, and the hospital is a wretched
abode, disgraceful to the town. . .. The poor-house
is in an old building in the most unwholesome part
of the town. There were about twenty paupers in
it, the dirtiest set of beings I ever saw. I found five
maniacs in the hospital, lying on straw upon the
floor, which looked as though it had not been swept
or washed for years. The citizens, however, are
engaged in measures to render these establishments
more comfortable.”
Among these measures, whether or not she was
aware of it, was the bequest by Ebenezer Knight
Dexter upon his death in 1824 of $60,000 (a sizable
sum for that period) for the benefit of the poor
people of the town. Plans were undertaken in 1826
to build an asylum in accordance with the provisions
of the will. Although the edifice was not completed
until 1830, occupancy began in 1828 with 64 pau-
pers, increasing gradually to a census of 125 in
1895. For some twenty years until the opening of
Butler Hospital it also provided shelter for the in-
sane, one quarter of its inmates at times belonging
to that category. According to Doctor George V.
Hersey it was the only maternity home in Rhode
Island before the opening of the Providence Lying-
In Hospital in 1884, “and many children have been
born beneath its sheltering roof.” Pending some
final litigation its days now appear to be numbered.
The first major medical institution in the city
resulted from a bequest of $30,000 in 1841 by
Nicholas Brown for the erection and endowment of
a retreat for the insane. This was followed by other
gifts, the largest amounting to $40,000 by Cyrus
Butler after whom the institution was to be named.
Chartered in 1844 it received its first patients in
1847. It began operations under the direction of
Doctor Isaac Ray, the first of a line of distinguished
superintendents. After a long career, during which
it had acquired an international reputation, it has
but recently closed its doors.
Another military medical establishment warrants
our attention. In 1862 under the supervision of the
War Department a general hospital was activated
at Portsmouth Grove, a locality in the town of
Portsmouth, Rhode Island. This obviously was a
major undertaking. Its first allotment of patients,
1724 in number, arrived on July 6th of that year.
The installation comprised 58 buildings, including
28 for wards and 30 for mess hall, kitchens, laun-
dry, stores, dispensary, commissary, enlisted and
officers’ quarters, blacksmith and carpenter shops
and other service facilities. It provided a chapel,
auditorium and library. Through August 1, 1863,
continued on next page
634
the first year of its operation, it received 6,866 pa-
tients, of whom 101 were to be buried in the at-
tached cemetery. At some point it acquired the
name Lovell General Hospital, a somewhat nostal-
gic one to a later generation of Rhode Island serv-
icemen and physicians. Its first commanding officer
was Doctor Francis L. Wheaton, son of Doctor
Levi Wheaton, a graduate of Brown University
Medical School and surgeon in the United States
Volunteers. Doctor Lewis A. Edwards, Surgeon
U.S.A., who succeeded him as commanding officer,
was unanimously elected on June 1, 1864, an honor-
ary member of the Rhode Island Medical Society,
attesting to the cordiality existing between the local
profession and the neighboring military medical
officers, a relationship which happily is still evident.
Doctors Appeal for City Hospital
On December 10, 1851, a committee of physi-
cians headed by Doctor Usher Parsons addressed
the following letter to the taxpayers of Providence:
“Sirs:
“The physicians of Providence have long felt
the want of a Hospital in this City for the recep-
tion of patients who require medical and surgical
treatment, and who are not otherwise provided
for. They meet with such patients in their pro-
fessional walks daily whilst to the public gen-
erally their great number rarely becomes known.
“It is true that some patients receive aid from
the Dispensary, and still more from the gratui-
tous services of Physicians and some few are sent
to the Dexter Asylum. But there are others,
badly lodged, often in garrets or cellars, without
light or ventilation, and open to the storms of
winter, who if honest are harassed by the idea of
accumulating rent, are destitute of wholesome
food and fuel, and unable to obtain good nursing.
Under such circumstances a hospital for their
reception, when suddenly overtaken with grave
disease or severe injuries would not only supply
what is needed, but would actually preserve many
lives.
‘Again, there are persons of good and indus-
trious habits, who meet with sickness or injury
just as they are entering into life, and who have
not had time to prepare for such a calamity... .
Such persons may fall from buildings, be
wounded on railroads, or in attempts to extin-
guish fires in our City, who in other cities are
conveyed to a good hospital to receive the best
medical or surgical aid, but in Providence are
carried to a crowded garret or cellar, where they
prefer suffering many privations during a linger-
ing cure, and incurring heavy expenses to be paid
for by future earnings, to being carried to the
RHODE ISLAND MEDICAL JOURNAL
Dexter Asylum, to dwell with paupers and the
victims of debauchery. The Asylum, however
spacious and well adapted it may have been ten
years ago, is now crowded with the offscourings
of Europe, and patients cannot receive proper
treatment without such a change in its arrange-
ments as would be incompatible with its ordinary
or legitimate uses. ;
“At the present, many persons afflicted with
chronic diseases, and requiring skillful opera-
tions and treatment, go from our City and State
to the well-established hospitals of Boston and
New York; and many others would avail them-
selves of that high privilege, but for want of
means. These, certainly, ought to be provided for
within our own State. ...
“As an earnest of their readiness to aid in
supporting a hospital, they engage to serve it
gratuitously as physicians or surgeons, whenever
they are required.”
This communication reached every taxpayer who
was assessed to pay a tax of $100 or more. The
letter is interesting in several respects. It empha-
sized the marked impact of the recent industrial
revolution on the economy and upon the way of life
in the city and state. A further complicating factor —
was the flood tide of immigration from Europe
which was having obvious effect upon the numbers
of sick poor requiring attention from the local
medical community. The inclination of the well-
to-do to travel to neghboring large cities for treat-
ment has a strangely familiar ring, and obviously
caused the profession some chagrin. Undoubtedly,
however, the plaintive reference to “that high privi-
lege”’ was largely inspired by altruistic motives.
This broadside produced no immediate reaction.
Consequently, in the following year a petition was
presented to the city government using much of the
same phraseology. The following remarks were
added: “No city of the population and wealth of
Providence has deferred so long a time to provide
a public hospital. ... We respectfully beg leave to
recommend that a hospital be provided by the city,
to be sustained by private subscriptions. . .. We
hope that you will appropriate .. . some . . . suitable
place for a hospital, on condition that fifty thou-
sand dollars be raised by private subscription.” The
City government in answer to this request ap-
pointed a committee to meet with the physicians to
examine the facts. There followed considerable
further delay during which the relative merits of
the Tockwotton estate and the “od hospital lot”
were weighed.
Moses Brown Ives, who died in 1857, left
$50,000 in trust for public benefactions. After
otherwise disposing of some $10,000, the trustees
were finally persuaded in 1863 to make the remain-
continued on page 638
635
YYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY
EDITORIALS
TYTT Tr trererreree
The RHODE ISLAND MEDICAL JOURNAL
Owned and Published Monthly by the Rhode Island Medical Society
106 Francis Street, Providence, Rhode Island
EDITORIAL BOARD
PETER PINEO CHASE, M.D., Editor-in-Chief, 122 Waterman Street, Providence
Joun E. Farre.i, Managing Editor, 106 Francis Street, Providence
CHARLES J. ASHWORTH, M.D.*
Avex M. BurRcGEss, M.D.
Joun E. Dontey, M.n.*
IrvinG A. BECK, M.D.
CHARLES L, FARRELL, M.D.
MARSHALL FULTON, M.D.
PETER F. HARRINGTON, M.D.
ERwIN O. Hirscu, M.D.
HENRI E. GAUTHIER, M.D.
Henry E. Utter, M.D.
SEEBERT J. GOLDOWSKY, M.D.
COMMITTEE ON PUBLICATION
(Members in addition to those marked above with asterisk*)
HERBERT FANGER, M.D., of Providence
Wit1aM J. MacDona_p, M.D., of Providence
Francis P. VosE, M.D., of Woonsocket
Ear J. Mara, M.D., of Pawtucket
Ropert W. RIEMER, M.D., of Providence
Vincent I. MAcANDREw, M.D., of Providence
MEDICAL EDUCATION
In the September number of the JouRNAL Doctor
Seebert J]. Goldowsky presented the first of three
papers on the history of medicine in Rhode Island.
We have a feeling that the modern doctor should
have a little more background than he seems usually
desirous of obtaining. It would save a lot of trouble.
One of the much advertised modern pieces of im-
pedimenta was essentially developed six hundred
years before Christ and promptly forgotten.
From its beginning when Doctor William Hun-
ter, a cousin of the famous eighteenth century
Hunter Brothers of England, started practicing in
Newport, Rhode Island has had a most excellent
medical history. Doctor Benjamin Waterhouse, of
Newport, gave us a lot of good information about
the early physicians. He, appointed in 1782 Pro-
fessor of the Theory and Practice of Physic at The
Harvard Medical School, was, despite his failings,
a great physician who was responsible for the in-
troduction of smallpox vaccination in America.
Doctor Usher Parsons, Naval hero surgeon of the
sattle of Lake Erie, and Doctor Solomon Drowne,
who developed his most interesting botanical gar-
den at Mount Hygeia in Foster, were brilliant
members of the ill-fated Brown Medical School.
More of that caliber were not uncommon in Rhode
Islancl’s medical history. We feel that we are for-
tunatc in having this careful and interesting story
brought to us by Doctor Goldowsky, and we trust
that you will all do yourself a lot of good by read-
ing it.
TELEPHONE LISTINGS
The action of the House of Delegates in clarify-
ing the local situation regarding telephone and other
directory listings is published elsewhere in this
issue (see House of Delegates, Committee on
Public Relations, page 647). The question of how
specialties should be publicized, and to what extent,
has been subject to review by many medical societies
throughout the country during the past year. Twice
our Society made rulings on the matter, and in
neither instance was the issue completely resolved.
The current action of the House of Delegates is
based on a comprehensive study by the Society’s
committee on public policy and relations that in-
cluded a report on the entire problem of so-called
physician advertising.
The adoption of these new regulations should be
recognized as an effort to assist the public primar-
ily, particularly in view of the increasing number
of physicians who now enter medical practice limit-
ing their work to a restricted field of service.
All directory listings must be limited by the spe-
cialty classifications posted by the Society in its
annual roster (see October issue of the R. I. MEp1-
CAL JOURNAL), and they are subject in addition to
final approval by the committee on public policy
and information.
continued on next page
636
The House rulings on newspaper announce-
ments, office signs, and program displays merely
establish as written regulations the procedures that
have been generally recognized by most physicians
through the years.
THE DOCTOR MICHAEL H. SULLIVAN
SCHOOL
late last August the people of the city of New-
port joined with their school committee for the
dedication of one of the newest schools in the state
an elementary school that will also serve as a
training school for students of Salve Regina Col-
lege who are entering the teaching profession—in
the name of Dr. Michael H. Sullivan, dean of the
active physicians of Rhode Island, and a past presi-
dent of our Society.
For fifty-four years Doctor Sullivan has engaged
in the general practice of medicine, and for more
than fifty of those years he has been chief of ob-
stetrics at Newport General hospital. In 1953 he
was cited by our Society as the “Practitioner of the
Year,” and he was lauded by the General Assembly
and the City Council of his own city. And when
the laudatory speeches had been said, the tributes
paid, and the awards given, Doctor Sullivan re-
sumed the daily rounds of his medical practice
unchanged not the least by it all.
And now a living memorial has been created for
one of the most beloved physicians in the state, and
we suspect that it is the kind of a memorial that
Doctor Sullivan likes best, for he has been the
physician at hand for more than 15,000 births in his
Newport area, and he has watched his thousands of
children grow up. Doctor Sullivan cannot be eulo-
gized adequately in type, as his hometown news-
paper pointedly stated in 1953 when it remarked
“print cannot reveal the gratitude people feel for
the man who has been physician and friend and
counselor and helper, so how can you write an edi-
torial about a man whose greatest editorial is writ-
DOCTOR MICHAEL H. SULLIVAN SCHOOL IN NEWPORT, RHODE
RHODE ISLAND MEDICAL JOURNAL
ten in the hearts of the people of the city he has
loved and that loves him.”
But Newport has found an admirable public ex-
pression for her favorite physician, and the hand-
some half million dollar building near the Middle-
town boundary line will be a fitting tribute to a
truly remarkable man.
CARE OF EXPERIMENTAL ANIMALS
We get many a request to announce meetings
and we have to let most of them, which are not par-
ticularly pertinent to our particular organization,
go by unnoticed. However, we are pleased to an-
nounce the forthcoming meeting of the Animal
Care Panel on December Ist and 2d, at the Henry
Hudson Hotel (353 West 57th Street ), New York
City.
The Animal Care Panel is an organization of
investigators, administrators of animal quarters,
animal breeders, food and cage manufacturers ; in
short, individuals interested in the care of experi-
mental animals. The program will consist of papers
dealing with the physiology and behavior of
laboratory animals, their diseases, nutrition and
related problems.
The anti-vivisectionists have striven hard to
make the public believe that we seize any stray
animals which we may find and torture them chiefly
because of our sadistic leanings. We do not believe
that any intelligent people really believe this, but
constant reiteration may fool the public. Of course,
there is no truth in this. First of ail, most of the
animals used in experiments have pedigrees that
would make the Kings of England look like up-
starts. When any of these experiments are started,
it is a pretty miserable thing to lose any of these
important animals. Therefore, we presume that
no human beings get the perfect care that these
animals get. We doubt if any of you go down to
New York, but we should emphasize the extreme
care these animals are getting.
Daily News Photo
ISLAND
NOVEMBER, 1955
TO ALL MY PATIENTS
The new A.M.A. pamphlet, titled To All My
Patients has been distributed to all members of the
Association. It is a fine public relations aid to your
medical practice that should be made available to
your patients.
The attractive twelve-page pamphlet describes
briefly the responsibilities of various persons on
the medical team, it discusses medical fees and
health insurance, and it encourages a friendly dis-
cussion of medical services and the fees charged
for them.
We know that physicians find their mail padded
with literally hundreds of brochures, pamphlets,
and leaflets emanating from many sources, and all
for the most part seeking to sell the doctor some
product or service. The pamphlet To All My
Patients should be read by every doctor, and copies
should be ordered from the A.M.A., or through
the state society executive office, for distribution
to your patients. The pamphlet may be left on
waiting room tables, or it may be mailed by you
to your patients since space has been provided on
the back cover for you to imprint your name, or a
mailing address.
Here is a fine new approach to help you and your
patients achieve that mutual undestanding so im-
portant to a successful doctor-patient relationship !
FUNDS FOR MEDICAL EDUCATION
The medical profession pledged two million dol-
lars annually in 1951 to assist the nation’s medical
schools, and through the efforts of the American
Medical Education Foundation more than one
million of that fund has been subscribed in each
of the past two years.
Recently every physician received a_ special
appeal signed by Doctor Hess, president of the
American Medical Association, urging continued
support of the program. The record shows that
Rhode Island physicians have contributed liber-
ally to medical school aid in recent years, although
the bulk of such contributions has been through
direct mailings to the schools rather than through
the AMEF.
Several state medical societies, including our
neighbor, Massachusetts, have contributed gifts
from their society treasury to aid the campaign.
Some states have made special assessments for the
same purpose. We have not felt that a special tax
is necessary upon our membership, and the record
indicates to the contrary that Rhode Island physi-
cians individually have supported medical educa-
tion through voluntary contributions to their
Tespec!ive schools.
637
But the situation in 1955 calls for increased
individual assistance to maintain our high medical
teaching standards without Federal subsidies, as
has been advocated in some quarters. We are
encouraged by the active support that industry has
given in recent years to further interest in college
and professional school training. We believe that
this spirit of cooperation should be strengthened,
and the best way to strengthen it would be for
higher individual donations by physicians to set
the example for giving by others.
E. P. ANTHONY, INC.
Druggists
Wilbur E. Johnston Raymond E. Johnston
178 ANGELL STREET
PROVIDENCE, R. I.
GAspee 1-2512
NEW “LONG TERM”
DISABILITY INSURANCE
ENROLLMENT PERIOD
for
R.I. Medical Society
members
has been extended for those
who are acceptable individually.
Members under age 61, in active
practice and with good health his-
tory are still eligible to enroll!
Applications and information will
be supplied, upon request, by:
R. A. Derosier Agency
Administrators
32 Custom House Street
Providence 3, Rhode Island
GAspee 1-1391
638
BEGINNINGS OF MEDICAL EDUCATION IN R. I.
continued from page 634
ing $40,000 available for hospital purposes. To
this was added $10,000 by his son, Captain Thomas
Poynton Ives. Thereupon the legislature granted a
suitable charter and the City of Providence appro-
priated the site of the old Marine Hospital, popu-
larly referred to as “Hospital Park.’’ Upon issu-
ance of the charter the list of corporators, which
had previously contained the names of doctors ex-
clusively, was enlarged by the addition of two hun-
dred names, “mostly non-professional gentlemen.”
A highly successful subscription campaign fol-
lowed, to which Doctor Parsons himself contrib-
uted one thousand dollars.
Medical Society Action
At its annual meeting on June 3, 1863, the Rhode
Island Medical Society passed the following reso-
lution: “That this society view with the deepest
interest the successful progress of the movement
for the foundation of a Rhode Island Hospital,—a
movement which began with the medical profession
of the City of Providence, but has now been en-
larged to embrace the whole state within the scope
of its beneficent operations ; and we promise the
corporators of the hospital all the aid and influence
we can furnish in its behalf, as physicians and
citizens.”
This was followed by the submission to the So-
ciety of a request for a “committee with whom the
committee on plans of this board may consult with
regard to the construction and arrangements of the
hospital buildings.” The Society acknowledged this
request and appointed such a committee on Decem-
ber 16, 1863. On June 1, 1864, at the annual meet-
ing, it was reported that this group had submitted
to the committee on plans “a detailed report in
writing.”
Rhode Island Hospital Opened
It is not germaine to the title of this paper to go
further into the plans and building of the new hos-
pital. Suffice it to say that no pains or expense were
spared to provide the community with the most
modern institution that the technology;of the period
could provide. The exercises celebtating the open-
ing of the new and imposing edifice took place on
October 1, 1868. The following are excerpts from
the remarks of Professor William Gammell of
Brown, the orator upon that impressive occasion :
“The need of a General Hospital for the sick and
the injured in the midst of a population so largely
employed in the mechanical arts, was first urged
upon public attention in this city by the gentlemen
of the medical profession, who, better than any
others, know how much life was lost, because there
was no such institution here. In October 1851, the
Providence Medical Association appointed a com-
RHODE ISLAND MEDICAL JOURNAL
mittee of their fraternity to consider the subject,
and to report a mode in which it might most efiec-
tually be brought to the consideration of the public.
This was done at the instance of their President,
Dr. Usher Parsons, our venerable friend, who to-
day beholds the full accomplishment of all his
benevolent plans.”
He referred to the grounds as “this beautiful and
salubrious site, which for three-quarters of a cen-
tury [ie. since 1789] had been used by the people
of Providence for hospital purposes.” He stated
further : “A hospital must take the lead in all medi-
cal departments. Its essential work should be thor-
oughly done, or it should not be attempted. It has,
therefore, been the aspiration of this corporation to
have a hospital building that is fully equal to the
highest standard of the age and as nearly perfect
as can be built....
“The hospitals of Philadelphia, New York and
Boston, have made those cities centers of medical
education for nearly the whole country. And with
the aid of the Rhode Island Hospital, why may we
not have a Rhode Island Medical School again
associated with our own University, as there used
to be some forty years ago. Indeed even without
any formal establishment for the purpose, the Hos-
pital will be, in itself, a school of practical medicine
of the greatest importance to the profession. It will
concentrate a knowledge of every form of disease;
it will bring together the results of varied experi-
ence; it will stimulate ingenuity, and suggest im-
provements and discoveries.’”” These were indeed
prophetic words.
At the annual meeting of the hespital on Novem-
ber 10, 1868, the president, Robert H. Ives, re-
ported : “On Tuesday, the 6th of October, the Hos-
pital received its first patient. It was a case requir-
ing a very severe surgical operation, which was
successfully performed on the following Saturday,
by the Visiting Surgeon in attendance, Dr. Mason,
and in the presence of the Consulting Surgeons,
who were summoned from all parts of the State.
The patient is favorably progressing toward recov-
ery.” This apparently was quite an event.*
*This patient was a 59-year-old shoemaker named John
Sutherland presenting necrosis of the upper jaw. Disease
of the antrum was suspected. The maxilla was resected
and the antrum was cleaned out. The specimen was
examined microscopically (presumably without staining)
and the impression of malignancy was confirmed. The
patient made an uneventful convalescence and was dis-
charged on December 7, two months following admission.
We could not do much better today.
The second surgical admission was a 55-year-old Irish
servant who was treated for a varicose ulcer with bed
rest and wet dressings. She was discharged healed after
three months.
The first medical admission was a 49-year-old German
gunsmith presenting “articular rheumatism.” He was dis-
charged after five weeks unimproved. These cases have 4
hauntingly familiar sound.
continued on page 640
NOVEMBER,
1955
MICTINE*—THE NEW ORAL DIURETIC
Searle MICTINE Provides Effective
Oral, Non-Mercurial Diuresis
The result of many years of research, Mic-
tine, brand of aminometramide, supplies a
long-felt need for an improved oral diuretic.
Mictine, 1-allyl-3-ethyl-6-aminotetrahy-
dropyrimidinedione, is not a mercurial, xan-
thine or sulfonamide.
Effectiveness: Every method for measuring
the diuretic effect in man now available,
Mictine is believed to act by the selective inhibition of the reabsorption of sodium
ions. Thus, the resulting diuresis is characterized by increased quantities of sodium
ions and water.
including precise human bioassay studies,
without exception demonstrated that Mic-
tine is an effective oral diuretic, and these
studies show that approximately 70 per cent
of unselected edematous patients treated
with Mictine by mouth respond with a sat-
isfactory diuresis.
Well-Tolerated: There are no known con-
traindications to Mictine, even in the pres-
ence of hepatic or renal damage, and there
SEARLE
is no risk of acidosis. On high dosage,
Mictine causes some side effects in some
patients but on three tablets daily these side
effects (anorexia and nausea, rarely vomiting,
diarrhea or headache) are minimal or absent.
Indications: Mictine is useful primarily in
the maintenance of an edema-free state
and in the initial and continuing control of
patients in mild con-
gestive failure. Mictine
may be used also for
initial and continuing
diuresis in more severe
congestive states,
particularly when mer-
curial diuretics are
contraindicated.
Administration: The
usual dosage for the
average patient is one
to four tablets daily
with meals, in divided
doses on an interrupted schedule. An inter-
rupted dosage schedule may be accom-
plished by giving the drug on alternate days
or for three consecutive days and then omit-
ting it for four days.
For severe congestive states the dosage is
four to six tablets daily with meals, in di-
vided doses on interrupted schedules similar
to those already mentioned.
Supplied: Uncoated tablets of 200 mg.
*Trademark of G. D. Searle & Co.
640
BEGINNINGS OF MEDICAL EDUCATION IN R. I.
continued from page 638
Hospital Library Developed
The plans for the new hospital provided space
for a library and for a lecture room. In the annual
report of November 9, 1864, appears the following
statement: “The Library of the late Dr. Ezekiel
Fowler, of Woonsocket, in this State, bequeathed
by him to the Rhode Island Hospital, has been re-
ceived, and is now in the custody of the Board. The
Library consists of about four hundred volumes of
medical, surgical, biographical and miscellaneous
works. It will serve as a timely and valuable com-
mencement of a Hospital Library, which it is hoped
will continue to receive accessions by donations
from other friends of the Institution.’ Here is
good evidence that the trustees were deeply inter-
ested in the problem of education even before the
new hospital opened its doors. In the annual report
of November 13, 1867, the bequest of one hundred
volumes “of the more recent standard works” from
the library of the late Doctor J. Davis Jones was
announced. He had died prematurely at the age of
twenty-eight. This donation was “highly appre-
ciated as the gift of a young man who understood
its importance to the Medical and Surgical Depart-
ments of the Hospital. ... We earnestly commend
to public notice this instance of thoughtful liberality
at the commencement of our active operations as a
Hospital. The large and beautiful room designed
for the library and the museum, will be ready for
occupancy in the course of a few weeks. Valuable
books, specimens of morbid Anatomy, well exe-
cuted Anatomical drawings and models, Pathologi-
cal specimens and like means of illustrations will be
timely and most acceptable presents, and will add
largely to the usefulness of the Institution.”
Additional gifts of books at the time of the open-
ing of the hospital brought the total to some 1400
volumes, including 300 from the library of Doctor
Usher Parsons. One contribution included “up-
wards of three hundred volumes, mostly in the
French language, and a black walnut case for the
same” and another “a cabinet of very choice patho-
logical specimens.”
On December 16, 1868, shortly after the hospital
had started operations, the Rhode Island Medical
Society voted: “That all books, instruments and
apparatus belonging to the Society, and now in the
hands of the Cabinet Keepers, and Librarians : also,
any preparations belonging to the Society, be, and
they hereby are, presented to the Rhode Island Hos-
pital ; provided, the members of this Society shall
he permitted to have free use of them when de-
sired, subject to the rules of the hospital.” This
contribution included the original gift of 72 vol-
umes from the library of Doctor Caleb Fiske. By
1874 the hospital librarian, Doctor Charles L.
RHODE ISLAND MEDICAL JOURNAL
Leonard, was able to report that the library had
increased to 2000 volumes. The fate of this histori-
cally valuable collection is an unhappy one. Some
time during the year 1930, prior to the opening of
Peters House, the new residence building for in-
terns and residents, Doctor John M. Peters, then
superintendent of Rhode Island Hospital, felt the
need of disposing of the outmoded books in order
to provide additional space for other hospital serv-
ices. Unfortunately he appears to have been rather
unsentimental with respect to the historical value
of old books and prepared forthwith to sell them
for waste paper. A few discerning individuals sal-
vaged some of the more valuable specimens. The
rest of the library was scattered. The Rhode Island
Medical Society to which many rightfully belonged
appears to have been left out.
One other note is of interest. In’ the Annual
Report of November 10, 1869, appeared the follow-
ing ruling: “The Trustees may grant any practi-
tioner or student of medicine, of one year’s stand-
ing, a ticket of admission to follow the practice of
the Hospital for not more than one year.”
Doctor Usher Parsons, a surviving link with an
earlier excursion into medical education, lived to
see his dream realized. He was able to attend the
opening exercises of the hospital on October 1,
1868. Wrote his son, Professor Charles W. Par-
sons : “He was conducted to a seat on the platform,
and was kindly referred to in Professor Gammell’s
eloquent discourse [see above]. This compliment,
the last he was ever to receive on any public occa-
sion, gratified him very much. He wrote in his diary
the next day, with a trembling hand, ‘I feel very
happy for yesterday’s doings.’ He was present at
the first important surgical operation performed
there, October 10 [as Chief of Consultants]. His
death occurred two months later.
Medical School Hopes Revived
The hope expressed by Professor Gammell that
Rhode Island might yet see another medical school
was to linger on. Wrote Professor Parsons in 1881
in his history of Brown University Medical School:
“There has been no medical department in this in-
stitution since the advent of President Wayland,
and for almost fifty years there was no medical
man on the Faculty. ... Whether a medical school
will ever be revived here, is a question not of his-
tory, but of very doubtful forecast. Providence,
from a town of 15,000 inhabitants, has grown into
a city of more than 100,000. It contains a Hospital
and Dispensary, both furnishing opportunities for
clinical instruction far surpassing any that the Pro-
fessor of Theory and Practice of Medicine could
command in Dr. Messer’s time. The University
has for several years shown great hospitality to
those physical sciences which are tributary to the
medical art, . . . zoology, botany, chemistry and
: continued on page 650
NOVEMBER, 1955
Trasentine’-Phenobarbital
s Inhibits Parasympathetic Activity
# Relaxes Smooth Muscle Directly
ws Exerts Local Anesthetic Effect
on G-I Mucosa
s Sedates the Patient
Without Atropine Side Effects
Each tablet contains 50 mg.
Trasentine hydrochloride and 20 mg.
phenobarbital.
Also available: Trasentine
hydrochloride Tablets, 75 mg.
Trasentine® hydrochloride
(adiphenine hydrochloride CIBA)
C IBA Summit, v. 2.
MEDICAL HORIZONS [Y MonisyM.
RHODE ISLAND MEDICAL JOURNAL
TUTUU UU UU UNCUT UUTUNUUTTUUNTUUUCUTINTUUCCE VT UTE e Pere erry Ty TT
HOUSE OF DELEGATES
of the
RHODE ISLAND MEDICAL SOCIETY
Report of Meeting, September 28, 1955
P Spear of the House of Delegates of the
Rhode Island Medical Society was held at the
Medical Library on Wednesday, September 28,
1955. The meeting was called to order by the presi-
dent, Frank B. Cutts, M.D., at 8:15 p.m. The fol-
lowing delegates were in attendance :
KENT COUNTY: Edmund
M.D.; Russell P. Hager, M.D. NEWPORT
COUNTY: Henry W. Brownell, M.D. PAW-
TUCKET DISTRICT: Robert C. Hayes, M.D. ;
Henry E. Turner, M.D.; Harold A. Woodcome,
M.D.; Hrad H. Zolmian, M.D. WASHINGTON
COUNTY: James A. McGrath, M.D. PROVI-
DENCE MEDICAL: Charles J. Ashworth, M.D. ;
Irving A. Beck, M.D.; Alex M. Burgess, Jr., M.D. ;
Wilfred I. Carney, M.D.; William B. Cohen,
M.D.; Edmund B. Curran, M.D.; John A. Dillon,
M.D.; Michael DiMaio, M.D.; William J. H.
Fischer, Jr., M.D.; John C. Ham, M.D.; Hannibal
Hamlin, M.D.; William S. Nerone, M.D.; Arnold
Porter, M.D.; Louis A. Sage, M.D.; Lee G. San-
nella, M.D.; William J. Schwab, M.D.; George W.
Waterman, M.D. OFFICERS OF THE RIMS
(other than delegates): Frank B. Cutts, M.D.;
Thomas Perry, Jr., M.D.; John G. Walsh, M.D.
IMMEDIATE PAST PRESIDENT OF THE
R. I. MEDICAL SOCIETY (without vote):
Henri E. Gauthier, M.D. WOONSOCKET
DISTRICT: Francis P. Vase, M.D.
Also in attendance were Doctors John T. Barrett,
chairman of the Child and School Health Relations
Committee ; David Freedman, trustee of the Benev-
olence Fund; Earl J. Mara, chairman of the Social
Welfare Committee ; Francis B. Sargent, chairman
of the Group Liability Insurance Committee ; and
John E. Farrell, Se.D., Executive Secretary.
REPORT OF THE CHILD AND SCHOOL
HEALTH RELATIONS COMMITTEE
Dr. John T. Barrett, chairman of the Child-and
School Health Relations Committee, reported on
the status of the distribution of polio vaccine in
Rhode Island. He related the development of the
State Advisory Committee, and he briefly reviewed
the meetings held by this Committee. He indicated
that in view of the federal regulations restricting
the use of the vaccine received by the state on a
C. Hackman,
matching fund basis, the Committee had accepted
the ruling that children in the age group, 5 to 9,
should receive first priority, then the age group,
1 to 5, after which pregnant women and other adults
would be eligible. He stated that $135,000 had been
allocated to the state of Rhode Island to be used
prior to next June, and this amount would purchase
approximately 150,000 cc. of the vaccine. No
means test is to be included in the distribution
which is to be carried out in clinics established by
the State Department of Health. Dr. Barrett stated
that the small quantity of vaccine available at the
present time forced the decision to handle all of it
presently through the public agencies.
Action: The report was discussed briefly by the
members of the House after which the sentiment of
the House was expressed that the Child and School
Health Relations Committee should issue any state-
ment necessary regarding the distribution of the
polio vaccine in Rhode Island for publication in the
Ruope IsLtAND MepicaL JourNAL for the in-
formation of the members.
MINUTES OF THE PREVIOUS MEETING
The minutes of the previous meeting of the
House of Delegates, distributed in mimeographed
form to each member and subsequently published
in the RHopE IsLanD MEDICAL JOURNAL, were
approved for permanent file.
REPORT OF THE SECRETARY
Dr. Thomas Perry, Jr., secretary of the Society.
submitted the following report :
The council has held one meeting since the last
meeting of the House of Delegates. Among mat-
ters resolved were the following :
1. The report of the trustees of the Caleb Fiske
Fund was received relative to the 1955 prize
dissertation, and approved.
. The Council was notified that the request of
the Society to the American Medical Associa-
tion that AMA dues be assessed directly from
its Chicago headquarters office would entail a
bylaw change for the Association not con-
templated at this time.
3. Dr. Francis V. Corrigan, Chief of the Divi-
sion of Maternal and Child Health of the
continued on page 644
Uleer protection
that
lasts all night:
&
Pamine syrup
Bromide
Each 5 cc. (approx. 1 tsp.) contains:
Methscopolamine bromide
1.25 mg.
Dosage:
1 to 2 teaspoonfuls three or four
times daily.
Supplied:
Bottles of 4 fluidounces.
The Upjohn Company, Kalamazoo, Michigan
HOUSE OF DELEGATES
continued from page 642
Rhode Island State Department of Health,
was designated to represent the Society at the
Fifth National Conference on Physicians and
Schools to be held at Highland Park, Illinois,
in October, if he finds it possible to attend the
meeting.
. Dr. Charles J. Ashworth, Chairman of the
Society’s Committee on Federal Medical
Services, and the Executive Secretary were
designated as official delegates of the Society
to a regional legislative conference under the
auspices of the American Medical Association
to be held in New York City on October 29
and 30,
. Dr. Walter E. Campbell, Chairman of the
Society’s Committee on Mental Health, was
designated as the Society’s official delegate to
the Second National Conference of State So-
ciety Representatives to confer on mental
health problems, the meeting to be held in
Chicago in November.
. A resolution adopted at the Annual Meeting
of the Rhode Island Pharmaceutical Associa-
tion was referred to the Society’s Committee
on Medical-Pharmaceutical Relations.
A special report from the Committee on
Medical Defense and Grievance was received
and placed on file.
. The Committee on Mental Health of the So-
ciety was asked to confer with Butler Hospital
authorities relative to the storage and avail-
ability to Rhode Island physicians of the
medical records of the Hospital.
. The Committees on Medical Economics and
Social Welfare were asked to give considera-
tion to a review of the Uniform Fee Schedule
for Governmental Agencies first adopted in
1950.
. The Board of Trustees were requested to se-
cure estimates for the costs of necessary im-
provements to the Library building.
Butterfield’s
DRUG STORE
Corner Chalkstone & Academy Aves.
ELMHURST 1-1957
RHODE
11.
ISLAND MEDICAL JOURNAL
The Board of Trustees of the Library were
authorized to place an appropriate marker on
the lectern in the Library auditorium to indi-
cate that it is a gift of Dr. Stanley Freedinan
of Providence.
. A proposed budget for the Society for 1956,
as submitted by the Treasurer, was approved.
. The Treasurer was instructed to transfer to
the Agency Account of the Society the be-
quest from the Estate of the Late Dr. Jesse E.
Mowry for investment.
. A committee was authorized to study recom-
mendations made by the Chairman of the
Library Committee and to report to the Coun-
cil at a future date.
. Membership of the Society in the Council
of the New England State Medical Societies
was renewed, and Drs. Frank B. Cutts,
Charles J. Ashworth and Thomas Perry, Jr.,
were named as the Society’s official delegates
to this Council.
. The State Director of Health was requested
to recall from circulation the booklet issued
recently by the Department listing a registrar
of physicians in Rhode Island for the reason
that it lists specialty designations which are
not accurate and which should not be listed in
such a publication, it has many errors, and it
lists osteopathic physicians in the registrar of
doctors of medicine.
Action: It was moved that the report of the Sec-
retary be received and approved and the actions
taken by the Council, as reported, be approved. The
motion was seconded and adopted.
Recommendation from the Council
The Secretary reported the following recommen-
dation from the Council :
To meet the anticipated expenses of the Society
as proposed in the budget for 1956, the Council
recommends that the dues in 1956 for active Fel-
lows be $50, except that Fellows in their first year
of practice shall pay dues of $25.
Action: It was moved to adopt the recommenda-
tion. The motion was seconded and adopted.
Report of the Treasurer
Dr. John A. Dillon, Treasurer of the Society,
submitted the following report:
With the death this summer of the widow of
Dr. Jesse E. Mowry, onetime president, and for
nineteen years Treasurer of the Society, the Rhode
Island Medical Society received 5% of his trust
estate to be held in trust as the Jesse E. Mowry
Fund, the income from which is to be used toward
current expenses of the Society. The trust
amounted to $6,131.54, which has been turned over
to our Agency, the Industrial Trust Company, for
investment in accordance with the action taken by
|
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NOVEMBER, 1955
the Council at its recent meeting.
The proposed budget for the Society approved
by the Council is predicated on our experiences of
the past few years, and it duplicates to a great ex-
tent our current budget for this year. The antici-
pated receipts from all sources are expected to be
about $44,000 and our anticipated expenses will be
approximately $42,000 with an anticipated $1800
held for a contingency fund.
The improvements to the Library building ini-
tiated last year when the annual assessment was
increased primarily for that purpose, will be con-
tinued in the coming months, as the Trustees of the
Library building have indicated that our property
is in need of many improvements.
Action: It was moved that the report of the
Treasurer be received and approved. The motion
was seconded and adopted.
Communications
The Secretary reported receipt of a communica-
tion from the Pawtucket Medical Association re-
garding the Society's poll relative to Social Security
coverage for physicians.
The Secretary read the results of the poll, as
previously reported to the members of the House
of Delegates individually, and he explained at length
the position of the American Medical Association
relative to Social Security coverage for physicians.
Committee on Group Liability Insurance
Dr. Francis B. Sargent, Chairman of the Com-
mittee on Group Liability Insurance, reported that
the Society's program had enrolled 148 members,
but that 43 had been rejected because of the insur-
ance company’s underwriting regulations. He dis-
cussed the problem as presented by the insurance
company regarding coverage for anesthetists, radi-
ologists and psychiatrists. He expressed the hope
that the gradual development of the program would
make it possible within a year to authorize coverage
for every physician regardless of his specialty.
Action: It was moved that the report of the
Group Liability Insurance Committee be approved
as presented. The motion was seconded and
adopted.
Committee on Social Welfare
Dr. Earl J. Mara, Chairman of the Committee
on Social Welfare, reported that several meetings
had been held of his Committee to revise the 1952
Provisions for the Purchase of Physicians’ Service
trom the Public Assistance Funds. He reviewed
many of the problems discussed and resolved by his
Committee and the State Department of Social
Welfare, and he called attention to the new bro-
chure which had been issued to the membership of
the Society effective September 1, 1955.
Dr. Cutts commended Dr. Mara and his Com-
continued on next page
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mittee for the excellent work it has done in adjudi-
cating problems between the profession and the
State Department of Social Welfare.
Action: It was moved that the report of the Com-
mittee on Social Welfare be approved as presented.
The motion was seconded and adopted.
Chemotherapy for Patients with Tuberculosis
Dr. John C. Ham submitted the following report
of the meeting held on August 17th at the State De-
partment of Health which the Medical Director of
the State Division of Tuberculosis Control had
requested him to present to the Society for possible
endorsement. The report is as follows:
It is noted that there has been an increasing con-
cern regarding chemotherapy for patients with tu-
berculosis on an out-patient basis. We have been
confronted with the problem of open cases of tuber-
culosis refusing hospitalization on the basis that
chemotherapy could be provided by private physi-
cians outside the sanatorium. In order to obtain the
best medical thought regarding this problem a meet-
ing was called by the Director of the State Division
of Tuberculosis Control in the Rhode Island De-
partment of Health of representative physicians
and social workers in this field.
Representatives of official health and welfare
agencies are generally agreed that ambulatory home
treatment of tuberculosis is not an ideal one. There-
fore, we cannot rightfully expend State funds to
encourage patients to reject the use of the excellent
sanatorium facilities available in this State, and
thereby continue as potential sources of infection
in the community.
On the other hand, it would be unfair to withhold
such treatment from deserving patients who are
temperamentally unable to adapt themselves to
sanatorium life. It would also be unfair to the com-
munity to treat the so-called recalcitrant patient as
an outcast and deprive him of the benefits of home
treatment merely because of his unwillingness to
cooperate. Such treatment will, in a number of
cases, bring the disease under control to the ulti-
mate benefit of both the individual and the com-
munity.
The outcome of this meeting, therefore, was a
unanimous agreement that drugs for ambulatory
chemotherapy should be made available to all pa-
tients, provided certain basic requirements are sat-
isfied ; namely :
1. That the disease is reported to the Rhode
Island State Department of Health.
That the patient is under the continuous medi-
cal supervision of a licensed physician.
. That the patient is financially unable to pur-
chase the needed drugs.
. That the patient’s condition is periodically re-
viewed at intervals of not longer than four
months by the Division of Tuberculosis Con-
trol, or by an examiner approved by said
Division. This particular review shal! consist
on
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of a chest X-ray and a sputum examination
as a minimum requirement.
. That reports of this particular review by the
Director of Tuberculosis Control, or by the
approved examiner, be sent to the paying
agency and attending physician.
Action: It was moved by the House of Delegates
that the report as submitted and the recommenda-
tions incorporated therein be approved. The mo-
tion was seconded and adopted.
Report of the Committee on Public Relations
Dr. Arnold Porter, Chairman of the Committee
on Public Relations, submitted the report of his
Committee as follows:
Atits April, 1955, meeting the House of Delegates
referred to the Committee on Public Policy and
Relations the recommendation it had received from
the Providence Medical Association requesting that
the entire problem of physician advertising, with
particular reference to office display signs, tele-
phone directory listings, newspaper displays, etc.,
be reviewed. This Committee was requested to re-
port to the House of Delegates at its September
meeting. Our report follows:
The question of how to list physicians’ names in
the classified (yellow) pages of telephone direc-
tories has been raised frequently by many medical
societies. We have made three decisions in as many
years on the problem in Rhode Island. It is the
general rule that the responsibility for proper list-
ing has traditionally been accepted by the physician
himself or by the county medical society since local
problems, customs and telephone company policies
are more readily understood and, if necessary, ad-
justed at that level. Hence there is no universal
rule in the matter, nor has the AMA taken any
action.
In an effort to summarize the picture throughout
the country the Public Relations Department of the
AMA checked the way in which physicians’ names
appear in the telephone directories of 90 cities and
towns in 33 states, the District of Columbia and
Hawaii. A summary of the findings is attached to
and made a part of this report.
Your Committee has reviewed the problem of
telephone listings, and the allied issues relating to
publicizing the physician’s name, and it presents the
following recommendations for consideration by
the House of Delegates:
1. Telephone and Other Directory Listings: As
an aid to the public specialty listings by physi-
cians should be permitted only on the basis of
specialty classification as listed by the RHopE
IsLAND MEDICAL JOURNAL, and subject in
addition to final approval by the Committee on
Public Policy and Relations. All such spe-
cialty listings in any public directories should
not be in bold type or otherwise prominent
display type.
continued on next page
648
2
Newspaper Displays: Newspaper displays
should be permitted not to exceed two columns
in width and two inches in depth, and not to
exceed publication in more than six issues of
each newspaper within a one-week period, to
announce—
a. The establishment of an office for the prac-
tice of medicine.
. To announce a change of office address.
+. To announce resumption of practice after
a term of duty with the Armed Forces of
the United States, or after an absence from
practice for a period of three or more
months, or after a long period of illness.
Office Signs: Office signs should list only the
physician’s name and the abbreviation M.D.,
and should be consistent with local customs
and precedents. Specialty listings should not
be placed on office signs. Ordinary illumina-
tion of office signs is permissible for physi-
cians having night office hours, or residing in
urban or rural areas, or where off-street light-
ing offers poor visibility of the physician’s
office entrance.
. Display Advertisements in Programs, etc.:
The Code of Ethics provides that “solicitation
of patients, directly or indirectly, by a physi-
MARK
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are x-ed off any chart
with a good supply of re-
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AY Gite
RHODE ISLAND MEDICAL JOURNAL
cian is unethical.” It would appear that some
paid display notices in programs, such as those
prepared for charity organizations and the
like, are a form of indirect solicitation, when
the physician’s name is listed as the donor of
the cost for the display. Such paid displays,
in the opinion of the Committee, should not
be approved. The listing of a physician as a
patron in a list would be permissible.
Action: It was moved that recommendations 2,
3 and 4 be approved by the House of Delegates.
The motion was seconded and adopted.
K 2K oK
It was moved that recommendation 1 be adopted.
The motion was seconded.
Discussion: There was discussion of this recom-
mendation after which, by request of the House,
the President called for a vote by a show of hands.
Fourteen (14) voted “Yes” for adoption and
twelve (12) voted “No.” The recommendation
was therefore adopted.
Physicians Service
Dr. Charles J. Ashworth, President of Physi-
cians Service, briefly discussed the addition of
X-ray benefits effective October 1, 1955. He ex-
pressed the hope that every physician would feel a
sense of personal responsibility in seeing that the
new benefit is not abused since the expansion of the
program represents a major step for Physicians
Service.
Report of the Committee on
Scientific Work and Annual Meeting
Dr. Henri E. Gauthier, Chairman of this Com-
mittee, reported on the program for the Interim
Meeting of the Society to be held on October 26,
1955.
He also reported on the Clinical Session of the
American Medical Association to be held in Boston
on November 29th to December 2nd.
Benevolence Fund
At the request of the President, the Executive
Secretary briefly reviewed the history of the pro-
posed Benevolence Fund and he submitted a new
indenture drafted by the Legal Counsel.
Dr. David Freedman, one of the original Trus-
tees of the Benevolence Fund, discussed the plans
for activating a program and he submitted the fol-
lowing two resolutions :
Resolved: That all prior action of the House of
Delegates in approving a Benevolence Fund be and
hereby is rescinded, declared void and of no effect.
concluded on page 650
NOVEMBER, 1955
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Write for details or contact your local FOOT-SO-PORT
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Foot-so-Port Shoe Company, Oconomowoc, Wis.
RHODE ISLAND MEDICAL JOURNAL
HOUSE OF DELEGATES
concluded from page 648
Resolved: That the indenture of the Benevolence
Fund of the Rhode Island Medical Society sub-
stantially in the form presented to this meeting be
and hereby is adopted and approved ; that a copy
attested by the Secretary be attached to the minutes
of this meeting ; that the President be and hereby is
authorized to execute and deliver a copy of the in-
denture of the Benevolence Fund to the Trustees
thereof ; and that the following be and hereby are
elected Trustees of said Benevolence Fund to hold
office for said terms and until their successors are
duly qualified and elected: Dr. David Freedman,
3 years; Dr. George W. Waterman, 2 years; and
Dr. Henry J. Hanley, 1 year.
Action: It was moved that the recommendations
relative to the Benevolence Fund be adopted. The
motion was seconded and adopted.
x ok Ox
The meeting adjourned at 10:12 p.m.
Respectfully submitted,
THOMAS PERRY, JR., M.D., Secretary
BEGINNINGS OF MEDICAL EDUCATION IN R. |.
continued from page 640
physiology. Its liberal spirit gives assurance that
it would welcome the addition of a medical school
to its other departments, if the community and the
profession should be ready to demand it... .
Whether this city, the second in New England, shall
become the seat of such a school must depend very
much on the zeal, persistence and ability of its
physicians.”
This was not the last. On a visit to Providence
in 1899 William Osler delivered the following re-
marks before the Rhode Island Medical Society:
“The existing conditions in Providence are singu-
larly favorable for a small first-class school. Here
are college laboratories of physics, chemistry and
biology, and modern hospitals with three hundred
beds. What is lacking? Neither zeal, persistence
nor ability on the part of the physicians, but a gen-
erous donation to the University of a million dollars
with which to equip and endow laboratories of
anatomy, physiology, pathology and hygiene. These
alone are lacking; the money should be the least
difficult thing to get in this plutocratic town. The
day has come for small medical schools in university
towns with good clinical facilities.”
Evidently the plutocrats failed to take the bait.
In 1955 we have an abundance of medical educa-
tion, but still no medical school.
ACKNOWLEGMENT.—I wish to express my sil-
cere appreciation to Mrs. Helen DeJong of the
Rhode Island Medical Society Library and to Miss
Marion Brown of the Special Collections ‘epart-
NOVEMBER, 1955
ment of the John Hay Library at Brown University
for their invaluable assistance in bibliographical
research. I should like also to remember Miss Marie
Clair, my faithful secretary, for her sympathetic
criticism and patient attention to detail, and in addi-
tion all those who have aided me with the chore of
proofreading and with helpful suggestions.
BIBLIOGRAPHY
1Anon.: The Brown Medical School, 1811-1827, The
3rown Alumni Monthly 5:162, 1905
2Bartlett, Elisha: Essay on the Philosophy of Medical
Science, Philadelphia, Lea and Blanchard, 1844
3Bartlett, Elisha: The History, Diagnosis and Treatment
of Typhoid and Typhus Fever with an Essay on the
Diagnosis of Bilious Remittent and of Yellow Fever,
Philadelphia, Lea and Blanchard, 1842
4Beaumont, William: A Case of Wounded Stomach, The
American Medical Recorder (Philadelphia) 8:14, 1825
5Beaumont, William: Experiments and Observation on
the Gastric Juice and the Physiology of Digestion, Platts-
burg, F. P. Allan, 1833
6Bronson, Walter C.: The History of Brown University
1764-1914, Providence, Brown University, 1914
7Brown, Moses: Private Papers. (RIHS)
8Carroll, Charles: Rhode Island; Three Centuries of
Democracy, 4 Vols., New York, Lewis Historical Pub-
lishing Co., Inc., 1932
Chapin, Charles V.: Epedemics and Medical Institutions ;
State of Rhode Island and Providence Plantations, 3
Vols., edited by Edward Field, Boston and Syracuse,
Mason Publishing Co., Vol. 2, pp. 1-77, 1902
/Drowne, Sclomon: Letter addressed to the Corporation
of Brown University dated 1824 pertaining to his salary
as professor. (MS, JHL)
11Drowne, Solomon, and Wheaton, Levi: Letters addressed
to the Fellows of Brown University, Providence, dated
Sept. 5, 1827 and Sept. 3, 1828 pertaining to the awarding
of degrees following the closing of the Medical School.
(MS, JHL)
12Fleming, Donald: Science and Technology in Providence
1760 to 1914, Providence, Brown University, 1952
Gorham, Frederick P.: The Old Medical School in
Brown University, Providence M. J. 16:218, 1915
'4Greene, Welcome A.: The Providence Plantations for
250 Years, Providence, J. A. and R. A. Reid, 1886
Guild, Reuben A.: History of Brown University, Provi-
dence, Brown University, 1864
Haley, John W.: The Old Stone Bank History of Rhode
Island, Vol. 4, Providence, Providence Institution for
Savings, 1944
“Harrington, Thomas F.: The Harvard Medical School,
History, Narrative and Documentary, 3 Vols., New York
and Chicago, Lewis Publishing Co., 1905
'SHayward, John: The New England Gazetteer ; Contain-
ing Descriptions of all the States, Counties, and Towns
in New England, 6th Ed., Concord, N. H., Boston, Israel
3oyd and William White, 1839
Hedges, James B.: The Browns of Providence Planta-
tions, Cambridge, Harvard University Press, 1952
“Hersey, George D.: The Medical History of the Colony
and State of Rhode Island; The New England States,
4 Vols. Boston, D. H. Hurd & Co., 1897, Vol. 4, pp.
2480-2499
*'Her-ey, George D.: The Medical Library as a Factor in
Medical Progress, Trans. of the R. I. Medical Society
6:16, 1900
concluded on page 660
Wherever you go
forget your telephone calls
We'll take them for you,
day or night.
MEDICAL BUREAU of the
Providence Medical Association
Fuller
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Located on Rt. 1
South Attleboro, Massachusetts
A modern non-profit hospital for the care and treatment of
nervous and emotional disorders as well as long term geriatric
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Physical, neurological, psychiatric and psychological exam-
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Modern recognized psychiatric therapies.
A pleasant homelike atmosphere in a beautiful and conveni-
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L. A. Senseman, M.D., F.A.P.A., Medical Director
Edwin Dunlop, M.D. Oscar E. Stapans, M.D.
Oliver S. Lindberg, M.D. Michael G. Touloumtzis, M.A.
William H. Dunn, M.S.W.
Referred patients are seen daily (except Saturdays) 9-12 A.M.,
and by appointment.
R. |. Blue Cross Benefits Tel. Southgate 1-8500
Special Rates for Long-Term Care
RHODE ISLAND MEDICAL JOURNAL
DISTRICT MEDICAL
SOCIETY MEETINGS
NEWPORT COUNTY MEDICAL SOCIETY
A meeting of the Newport Medical Society was
called to order at 8:30 p.m. on September 28 by
Dr. Robert Bestoso, President.
The meeting took place at the Hotel Viking with
twenty-two members attending. The minutes of
the previous meeting were read and approved.
The applications to the County Medical Society
of Dr. Olga Torres, Dr. Anthony Carrellas and
Dr. William F. Thompson were read before the
Society and were referred to the Board of Censors.
It was accepted that the payments for the yellow
page telephone listings be paid henceforth by the
Society and not by the Hospital.
The Secretary was instructed to write to the Fall
River Medical Society concerning what was con-
sidered as unethical advertising by Fall River prac-
titioners of their specialties in the Newport tele-
phone directory. He was in addition, instructed to
send a letter to this effect to the A.M.A.
NEW BUSINESS. A motion was made that
the critical situation at the hospital parking lot for
doctors be referred to the director of the hospital
for serious consideration, and that steps be taken
that the parking lot be reserved unconditionally for
doctors during the morning hours. This was sec-
onded by the Society and passed.
LIAISON COMMITTEE REPORTS. | Dr.
Callahan wished to be informed of the matters
which the Society, as a whole, would be concerned
with pertaining to the Physicians Service Plan.
It was unanimously agreed that we suggest the
plans give the subscribers first day coverage.
Dr. Ceppi wished, in view of difficulties that have
already ensued, that a standard procedure for hir-
ing and firing a school doctor be instituted and
arranged by the State Committee, and the Secretary
be instructed to forward this suggestion to the
State Society.
This motion was unanimously passed by the en-
tire Society.
The meeting adjourned at 10:30 p.m.
Respectfully submitted,
José M. Ramos, M.p., Secretary
PROVIDENCE MEDICAL ASSOCIATION
A regular meeting of the Providence Medical
Association was held at the Medical Library on
Monday, October 3, 1955. The meeting was called
to order by the President, Dr. Francis H. Chafee,
at 8:30 P.M.
The minutes of the previous meeting were ap-
proved as published in the RHopE IsLAND MeEpicaL
JOURNAL.
Report of the Secretary
Dr. Michael DiMaio, Secretary of the Associa-
tion, reported the following actions of the Execu-
tive Committee :
It approved the appointment by the President of
the Association of Drs. Merle M. Potter and Betty
Mathieu as the official delegates of the Association
at a Providence White House Conference on Edu-
cation.
It approved the appointment as a liaison commit-
tee between the members of the Association and the
administrative office and Claims Committee of
Physicians Service the following committee: Dr.
Joseph Hindle, Dr. Walter S. Jones, and Dr. Ernest
K. Landsteiner.
It approved the work of the Association’s Com-
mittee on Group Health and Accident Insurance,
and it commended the Committee for its work in
securing additional benefits for the members effec-
tive in September.
It approved the following changes in dates for
meetings of the Association in coming months:
1. That the December meeting be transferred to
Monday, November 28, in order to avoid conflicts
with the American Medical Association Interim
Session in Boston.
2. That the Annual Meeting be held on Monday,
January 9, instead of Monday, January 2, 1956.
The Executive Committee also approved the
appointment by the President of Dr. Joseph G.
McWilliams to fill the unexpired term on the
Executive Committee of Dr. David J. LaFia, who
has moved out of Rhode Island.
Action: It was moved that the report of the Sec-
retary and the actions of the Executive Committee
be received and approved. Motion was seconded
and adopted.
Report of the President
The President reported that the Secretary is n
receipt of obituary tributes to become permanent
records of the Association, as follows: to the late
continued on page 654
NOVEMBER, 1955
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Femandren® (methyltestosterone with ethinyl estradiol ciBa)
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MEDICAL HORIZONS | \f Monday P™
654
RHODE ISLAND MEDICAL JOURNAL
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PROVIDENCE MEDICAL ASSOCIATION
continued from page 652
Doctor George H. Alexander, prepared by Doctors
Henry H. Babcock and Arthur H. Ruggles ; to the
late Doctor John Langdon, prepared by Doctors
Henry E. Utter and William P. Buffum ; to the late
Doctor Harvey B. Sanborn, prepared by Doctors
Elihu S. Wing, Sr. and William Newton Hughes;
to the late Doctor George L. Shattuck, prepared by
Doctors Halsey DeWolf and Herbert G. Partridge.
He also reported that he had named as a com-
mittee to prepare the tribute to the late Doctor
Joseph C. O’Connell, Doctors John G. Walsh and
John E. Donley.
Doctor Chafee called for a moment of silence to
the memory of the physicians who died since the
last meeting of the Association.
Award of Membership Certificates
The President awarded membership certificates
to the physicians elected to active membership in
the Association at the April meeting.
Nominations for Membership
The Secretary reported that the Executive Com-
mittee recommends for election the following : Paul
Arthur Blackmore, M.D., 141 Waterman Street,
Providence, Rhode Island, sponsored by : Drs. John
Turner IT and Michael DiMaio ; Joseph E. Caruolo,
M.D., 400 Angell Street, Providence, sponsored
by: Drs. Edward Cardillo and Hilary H. Connor;
Robert E. Newhouse, M.D., 359 Broad Street,
Providence, sponsored by: Drs. John A. Rogue and
William F. Maher ; Joel S. Ordaz, M.D., 81 South
Angell Street, Providence, sponsored by : Drs. John
F. Gilman and Frederic W. Easton ; George Resne-
vic, M.D., Putnam Pike, Chepachet, sponsored by:
Drs. Joseph G. McWilliams and William S. Klutz;
Stanislava Resnevic, M.D., Putnam Pike, Che-
pachet, sponsored by: Drs. Hannibal Hamlin and
Thaddeus A. Krolicki; Lester L. Vargas, M.D.,
154 Waterman Street, Providence, sponsored by:
Drs. Thomas Perry, Jr. and John Turner II.
The Executive Committee also recommends for
re-election as an active member of the Society
Dr. John A. Picozzi, 358 Broadway, Providence.
Action: It was moved that the recommendations
regarding new members in the Association be ap-
proved. Motion was seconded and adopted.
Scientific Program
Dr. Chafee presented the panel for the Clinico-
pathological Conference as follows : :
Moderator: Marshall N. Fulton, M.D., Chief ot
Medical Service, Rhode Island Hospital.
Clinical Discussors: John C. Leonard, M.D.,
Director of Medical Education, Hartford Hospt-
tal: Associate Clinical Professor of Medicine, Yale
concluded on page 661
NOVEMBER, 1955
Headache is typical of the many
distressing but ill-defined symptoms of
estrogen deficiency which may occur long before
or after cessation of menstruation.
“Premarin”® (conjugated estrogens, equine) is an excellent
preparation for effective replacement therapy.
_ Ayerst Laboratories
New York, N. ¥. * Montreal, Canada
RHODE ISLAND MEDICAL JOURNAL
£6282 646 626266662 0928986882862 0 628 CC CE LEPEESEVIELEUALE VLE OPEEORE Se eevee ree...
BOOK REVIEWS
CASIMIR FUNK: PIONEERIN VITAMINS
AND HORMONES by Benjamin Harrow.
Dodd Mead and Company.
All physicians know that Casimir Funk did some
of the earliest work on, and gave the name to,
vitamins. Dr. Harrow, who is a chemist and in-
terested in the same type of work that Dr. Funk is,
and who is also a great friend of Dr. Funk, has
written this book which is almost a eulogy. I think
it will be very illuminating to many of the medical
profession.
Casimir Funk was a Pole of Russian domination
in his youth, but he worked in many of the countries
of Europe and got well acquainted with them and
their languages, and then worked in this country
where he is at the present time. If he is as good as
Dr. Harrow thinks he is, and I see no reason to
doubt it, he is a remarkable man. He has worked
at innumerable projects associated with vitamins
which broadly interpreted means that he pretty well
covers the field of bio-chemistry, and he has been
over and over a pioneer.
The book is divided into two parts. The first
largely concerned with his life, and the second with
the different problems which he has taken up.
I think the book will be an eye opener to most of
the men who read it, and we are delighted to have
it in our library.
PETER PINEO CHASE, M.D.
IL SANGUE E GLI ORGANI EMOLINFO-
POIETICI NELL’ INFEZIONE SIFILI-
TICA (The Blood and the Blood Forming Or-
gans in Syphilis) by Gian Battista Cottini. Edi-
toria Liviana, Padova, 1947
In this 238-page monograph of orientation toward
a better knowledge of the blood in syphilis, Cottini
says that, in general, the red blood cells and the
hemoglobin are diminished and the white blood cells
increased. These changes are not specific. It is in
accord with Fournier’s triad ; namely, less erythro-
cytes, less hemoglobin and leukocytosis. This ap-
plies also to prenatal syphilis.
The changes appear as a defense mechanisin of
reticulo - histiocytary - allergic nature. The bone
marrow and the spleen are considerably altered.
The monograph represents an important collec-
tion of data. It should be of interest and value to
the student of syphilology, who is trying to clarify
many uncertain points on the subject of blood and
syphilis.
F. RONCHESE, M.D.
SALT AND THE HEART by Edward T. Yorke,
M.D. Drapkin Books, Linden, N. J., 1953. $3.45
This is an interesting little book written by a
physician whose prime interest is cardiology. The
first part of the book is written in narrative style
and is devoted to the effect of salt on cardiovascular
disease, particularly congestive heart failure. This
portion of the book is very elementary but the
author’s approach to the subject is quite interest-
ing. The story is about an old, retired sea captain,
“Old Salt,” who is unable to tolerate the unre-
stricted use of salt in his daily diet.
The second part of the book is devoted to the
preparation of a low sodium diet which is, perhaps,
the most important part of the book. The subject is
presented in such a manner that even the layman
can prepare a low sodium diet with reasonable ac-
curacy. The book is recommended as supplemen-
tary reading for the general practitioner and the
layman.
MicHaeEt DiMaio, o.D.
OGGI NON VISITO ...PERCHE MI GIRA
... LASCIO IL TERMOMETRO...PREN-
DO LA LIRA (Closed Today .. . I Just Don't
Care... I Leave the Thermometer . . . and Take
Up the Lyre) by Ugo Piazza. Edizioni Minerva
Medica, Torino, 1955, Lire 1500
Dr. Piazza is a popular figure among the Italo-
Americans of Providence, since his visit to the city
two years ago and his weekly broadcasts from
Rome on station WRIB. Dr. Piazza has a large
family, a large dermatologic practice, right in the
heart of the Eternal City, and is kept busy by the
medical press. In addition to all these activities and
to relax from the busy daily routine, he composes
medical comical poetry of a most enjoyable kind.
His verses are coming out with the speed of a high
pressure pure water spring and are delightful.
concluded on page 658
NOVEMBER, 1955
Brittle, fragile or laminating fingernails are the
bane of many a woman’s existence. Yet this
highly prevalent and distressing condition often
has gone uncontrolled for lack of effective ther-
apy. Now, you can promise these patients sub-
stantial relief in a large percentage of cases.
In a recent study! that confirmed previous
work? Knox Gelatine was used to treat 36
women with fragile, brittle, laminating finger-
nails. The response was most gratifying. Except
for three patients who discontinued the therapy,
three diabetics, and two women who had con-
genital deformities, the splitting ceased and all
other patients were able to manicure their nails
to a full point by the time the study ended.
(ptimal dosage proved to be one envelope (7
grains) of Knox Gelatine administered daily for
Protein Previews
three months. Improvement, however, was noted
after the first month. If you would like more
complete details of this work, just use the coupon.
1. Rosenberg, S. and Oster, K. A., “‘Gelatine in the Treatment of
Brittle Nails,’’ Conn. State Med. J. 19:171-179, March 1955.
2. Tyson, T. L., J. Invest, Dermat. 14:323, May 1950.
‘Panett alana heehee ele lelae lalate tteetetetaielatey |
Chas. B. Knox Gelatine Company, Inc.
Professional Service Dept. RM-11
Johnstown, N. Y.
Please send me a reprint of the article by Rosenberg
and Oster with illustrated color brochure.
YOUR NAME AND ADDRESS |
As a Oe Se ae Sa ee as a
a A SS ES
658
BOOK REVIEWS
concluded from page 656
The poet-wit has a field day with our derma-
tologic puzzles, with the warring pediculus, the
spirochetes, the inevitable enema, the vitamins
craze, the detail man eloquence, etc., etc.
A serene, laughing Aesculapius, offering his
peaceful mind as a reminder that there is always
time for a good clean laugh.
The book is well illustrated by cartoonist Frata-
locchi.
The cartoon on allergy, for exampie, shows an
Italian forced to refuse a most alluring dish of
spaghetti because of the clam sauce. Interesting
are the verses devoted to medical history.
The book represents a valuable addition to our
unique Davenport collection of books by physicians
on non-medical subjects. I hope a Piazza-minded
colleague, versed in both languages, will give us an
English translation.
FF’. RONCHESE, M.D.
A TEXTBOOK OF PHYSIOLOGY. Edited by
John F. Fulton with the Collaboration of Others.
17th ed. W. B. Saunders Company. Phil., 1955.
$13.50
This new edition of physiology text presents
many revisions and additions to older concepts so
that even the recent medical graduate will find a
wealth of material to absorb. Exactly fifty years
have passed since the first edition by Doctor Howell
and five years since the sixteenth edition. Among
the contributors is Paul F. Fenton of our own
Brown University Biology Department writing on
the digestive system. Among the advances in fun-
damental physiology now included are completely
rewritten chapters on the physiology of the nervous
system (for which the book in the past was highly
regarded ), body fluids, kidney function, respiration
and a new chapter on energy transformation in
nerve cells and acetylcholine by Doctor David
Nachmansohn, the eminent authority in this field.
J. E. BRENNAN & COMPANY
Leo C. Clark, Jr., B.S., Reg. Pharm.
pApothecarnits
Pawtucket, R. I.
5 North Union Street
SHELDON BUILDING
7 Registered Pharmacists
RHODE ISLAND MEDICAL JOURNAL
Recent important change in concept of the regula-
tion of the autonomic nervous system by the \ is-
ceral brain is recognized by a new chapter on the
limbic system which brings to the fore the part
played by the cerebrum in regulating visceral func-
tion and patterns of emotional expression. It was
startling to read that the hypothalamus is no longer
considered the chief area of autonomic function in
the forebrain, but that in the oldest part of the
cerebral cortex there is a designated limbic system
to influence autonomic reactions. Although these
studies are in their infancy, they are providing a
rational basis for certain behavioral and EEG mani-
festations of psychomotor epilepsy.
To the reviewer the chapter on hemodynamics of
the blood was a welcome revelation of some of the
principles of the rapidly expanding field of rhe-
ology, the science of flow and elasticity, not easily
found elsewhere.
The illustrations, tables and references are well
up to date for a subject that expands as physiology
does. One instance was noted where the figures of
a table taken from another recent text on body
water were revised again by that author to be the
latest available data. The authors are to be com-
mended on their revisions and exclusion of un-
essential material making the subject matter more
digestible to the student and practitioner alike.
ABRAHAM SALTZMAN, M.D.
PRESENT-DAY PSYCHOLOGY edited by
A. A. Roback. Philosophical Library, New York,
1955. $12.00
This new anthology brings up to date the ex-
perimental work in human behavior. The compila-
tion covers the various areas of depth psychology
from the point of view of recognized experts in
each particular dissection of the human person.
The whole volume deserves attention because of
its fine presentation and clear exposition of the
present experimental situation and needs in the
areas considered.
Thumbing through this book leaves one with a
feeling of having had an adventure in the world of
psychological ideas. No matter what one’s personal
idea about psychology might be, he recognizes the
service this anthology renders to the profession in
the depth, scholarship and magnitude of the work
(995 pages).
For the student of psychology the full treatment
of basic issues in experimental psychology is pre-
sented in one volume. For the busy clinician and
doctor it is a sourcebook ready at hand.
The anthology should be a valuable addition to
the library of psychological literature.
Rosert G. QUINN, 0.P., A.M., M-ED.
NOVEMBER, 1955
NOW X-RAY
in the
Physicians Service Contract
EFFECTIVE: OCTOBER 1, 1955
Your Patients Will Expect You To Know That—
. The X-ray benefit covers only part of the charge for X rays.
. Credit will be allowed toward charges for diagnostic X rays
ordered by a physician in a DOCTOR’S OFFICE, or as an IN-
PATIENT or an OUT-PATIENT in a hospital.
- NO ALLOWANCE will be made for radium or X-ray therapy,
X rays in connection with a routine procedure on admission to
a hospital, or for routine physical examinations, or screening
miniature films, or fluoroscopic services, or dental X rays
(except in case of traumatic injury).
. Payment for ELECTROCARDIOGRAMS will be made to bed
patients ina hospital only. An allowance of $10 for each electro-
cardiogram, EXCLUDING THE FIRST ONE, will be made for
each hospital admission up to a maximum of $50.
RHODE ISLAND MEDICAL SOCIETY
PHYSICIANS SERVICE
660
BEGINNINGS OF MEDICAL EDUCATION IN R. I.
concluded from page 651
22Huntington, Elisha: An Address on the Life, Character,
and Writings of Elisha Bartlett, M.D., M.M.S.S., Pub-
lished by Middlesex North District Medical Society,
Lowell, Mass., S. J. Varney, 1856. (RIMS)
23K eefe, John W.: Traditions of Medicine in Rhode Island,
Boston Med. & Surg. J. 193 :899, 1925
24K rumbhaar, Edward B.: Dr. William Hunter of New-
port, Ann. Surg. 101 :506, 1935
25Mitchell, John W.: The Rhode Island Medical Society :
Dr. Amos Throop, Trans. of the R. I. Medical Society
4:135, 1890
26Morse, John T., Jr.: Life and Letters of Oliver Wendell
Holmes, 2 Vols., Cambridge, Mass., Riverside Press,
1896
27Munro, Walter L.: Early Medical History in Rhode
Island and the Rhode Island Medical Society, R.I.M.J.
18:93, 1935
28Qsler, William: A Rhode Island Philosopher (Elisha
Bartlett), Trans. of the R. I. Medical Society 6:15, 1899
29Parsons, Charles W.: Historical Sketches of the Rhode
Island Medical Society, Trans. of the R. I. Medical
Society 2:421, 1882
30Parsons, Charles W.: Memoir of Usher Parsons, M.D.,
Providence, Hammond, Angell Co., 1870
31Parsons, Charles W.: The Medical School Formerly
Existing in Brown University, Its Professors and Grad-
uates, Historical Tract No. 12, Providence, Sidney S.
Rider, 1881
82Parsons, Usher: Lecture on the Connection and Recip-
rocal Influence Between the Brain and the Stomach,
Providence, B. Cranston & Co., 1841. (RIMS)
33Parsons, Usher: Directions for Making Anatomical
Preparations, Philadelphia, Carey and Lea, 1831
34Parsons, Usher: On the Administration of Medicines
By the Veins, Being a Brief Inquiry into its Safety
and Utility, The American Medical Recorder (Phila-
delphia) 14:353, 1828
35Parsons, Usher: The Importance of the Science of
Anatomy and Physiology as a Branch of General Edu-
cation; Being an Introduction to a Course of Lectures
to the Upper Classes in Brown University, Cambridge,
Hilliard and Metcalfe, 1826. (Author’s presentation copy
to Pres. Asa Messer, RIMS)
36Parsons, Usher: Surgical Account of the Battle on Lake
Erie on the 10th of September 1883, New England J. of
Med. & Surg. 7 :313, 1818
87Parsons, Usher: On the Use of Alcohol in the Disease
Produced by the Bite of the Rattlesnake, The American
Medical Recorder (Philadelphia) 6:619, 1823
38Parsons, Usher: Cases of Gun Shot Wounds Through
the Thorax, with Remarks, New England J. of Med. &
Surg. 7:27, 1818
39Parsons, Usher: Letter on Some Points of Military
Surgery, Communications of the R. I. Medical Society
1:97, 1861
4°Parsons, Usher: Vegetable and Animal Decomposition
as a Cause of Fever, reprint extracted from Am. J. M. Sc.
for November 1831, Philadelphia, Joseph R. Skerrett,
1830
41Parsons, Usher: Sailor’s Physician, Containing Medical
Advice for Seamen and other Persons at Sea on the
Treatment of Diseases and on the Preservation of Health
in Sickly Climates, 2nd edition, Providence, Barnum
Field & Co., 1824. (RIMS)
42Parsons, Usher, et al: Letter Addressed to the Tax
Payers of Providence, December 10, 1851. (RIH)
48Parsons, Usher, et al: History of the Medical Profession
RHODE ISLAND MEDICAL JOURNAL
in Rhode Island, Communications of the R. I. Medical
Society 1 :3-64, 1859 -
44Peters, John M.: History of the Rhode Island Hospital,
R.I.M.J. 19 :155, 1936
45Peterson, Edward: History of Rhode Island, New York,
J. S. Taylor, 1853. (PPL)
46Rider, Sidney S.: A Brief Memoir of Dr. Elisha Bartlett
with Selections from His Writings and a Bibliography
of the Same, privately printed edition of 300 copies,
Providence, S. S. Rider, 1878. (PPL)
47Ross, Arthur A.: A Discourse Embracing the Civil and
Religious History of Rhode Island, Providence, H. H.
Brown, 1838
48Sherman, William S.: Some Notes on Early Medicine
and Surgery in Newport County, the Cradle of American
Medicine, R.I.M.J. 14:76-82, 1931
49Snow, Edwin M.: Report of the Superintendent of
Health Relative to the Small Pox Hospital, Provi-
dence, 1871. (RIMS)
50Stone, Edwin W.: Rhode Island in the Rebellion, Provi-
dence, George H. Whitney, 1864.
51Thacher, James: American Medical Biography, Boston,
Richardson & Lord and Cottons & Barnard, 1828
52Tilton, Eleanor M.: The Amiable Autocrat: A Biog-
raphy of Dr. Oliver Wendell Holmes, New York, Henry
Schuman, 1947
53Tingley, Louisa R.: Some Sidelights in the Biography of
My Great, Great Grandfather, Caleb Fiske, M.D.,
R.I.M.J. 15:163, 1932
54Waite, Frederick C.: The Third Medical College in
New England, That of Brown University (1811-1828),
New England J. Med. 207 :30, 1932
55Waterhouse, Benjamin W.: Medical Literature of Rhode
Island with a Sketch of Some of Her Most Eminent
Men, Boston Medical Intelligencer 2:49, 1824
56Wilson, J. Walter: The First Natural History Lectures
at Brown University, 1786, by Dr. Benjamin Waterhouse,
Ann. Med. History 4 :390, 1942
57Brown University Historical Documents, Vol. I. (JHL)
58The Biographical Cyclopedia of Representative Men of
Rhode Island, 2 Vols., edited by L. E. Rogers, Provi-
dence, National Biographical Publishing Co., 1881
59History of Providence County, Rhode Island, edited by
Richard M. Bayles, New York, W. W. Preston & Co.,
1891
60Lamb’s Biographical Dictionary of the United States,
8 Vols., edited by John Howard Brown, Boston, James
H. Lamb Co., 1900
61Pictures of Rhode Island in the Past, by Various Au-
thors, edited by Gertrude S. Kimball, Providence, Preston
and Rounds Co., 1900
62Representative Men and Old Families of Rhode Island,
3 Vols., Chicago, J. H. Beers and Co., 1908
63The History of the State of Rhode Island and Providence
Plantation, 5 Vols., edited by Thomas W. Bicknell, New
York, The American Historical Society, Inc., 1920
64Dictionary of American Biography, 20 Vols., New York,
Charles Scribner Sons, 1928
65Handbook of Historical Sites in Rhode Island, Provi-
dence, Department of Public Schools, 1936
66Providence Town Paper No. 995, Report of Committee
Recommending a Site for the Small Pox Hospital, July 2,
1776. (RIHS)
67Town Paper No. 12887, Bill Submitted for Materials
and Labor Incident to Construction of the “New Hos-
pital,” May 19, 1798. (RIHS)
68Map of the City of Providence Showing “Old” and
“New” Hospitals dated 1803. (RIHS)
69Brown University Medical Association: Constitution
and By-Laws; Minutes of Meetings, 1811 to 1825. (MS,
JHL)
Medi
of M
pital ;
Harv
Th
meml
As
first s
ful.
handl
Leon;
shall
of the
The
brone!
to the
also h:
The
Coll
Atte
NOVEMBER, 1955
Rhode Island Medical Society Records, 1812-1872. (MS,
RIMS)
7iCircular; Medical Lectures in Brown University, 1822.
(JHL)
72Catalogue of the Medical Institution of Brown Univer-
sity 1821-1822. Photostat of original copy at the Harvard
College Library. (JHL)
Catalogue of the Medical Department of Brown Uni-
versity 1822-1823. (JHL)
74Catalogues of the Officers and Students of Brown Uni-
versity 1820-1821 to 1835-1836. (JHL)
Boston Medical Intelligencer, Vol. 2, May 1824 to May
1825 (Miscellaneous Items).
76Minutes of Various Meetings of the Rhode Island Medi-
cal Society, Communications of the R. I. Medical Society
Vol. 1, 1860-1877
7United States Marine Hospital Service, First Annual
Report, Washington, 1872
8A Statement of the Library Committee of the Rhode
Island Medical Society, May 1, 1883. (Pamphlet RIMS)
Rhode Island Hospital Annual Reports, 1864 to 1954.
(RIH)
Report of the Joint Special Committee Relative to
Establishing a City Hospital for the Treatment of Con-
tagious Diseases, Providence, 1906. (RIMS)
First Annual Report of the Providence City Hospital,
Providence, 1910. (RIMS)
Quarantine Regulations for the Port of Providence,
R. I., Providence, 1831. (Broadside JHL)
KEY—JHL: John Hay Library, Brown University;
RIHS: Rhode Island Historical Society Library ;
PPL: Providence Public Library ;
RIMS: Rhode Island Medical Society Library ;
RIH: Rhode Island Hospital Library ;
MS: Manuscript.
PROVIDENCE MEDICAL ASSOCIATION
concluded from page 654
Medical School. Thomas A. Warthin, M.D., Chief
of Medical Service, West Roxbury Veterans Hos-
pital; Associate Clinical Professor of Medicine,
Harvard Medical School.
The summary of the case was submitted to the
membership in advance of the meeting.
As has been the case in the past two years, the
irst scientific meeting of the year was very success-
ful. The discussion of the case was excellently
handled by the visiting physicians, Dr. John C.
Leonard and Dr. Thomas A. Warthin. Dr. Mar-
shall N. Fulton did an excellent job as moderator
of the conference.
The diagnosis of the case was an undifferentiated
bronchogenic carcinoma of the lung with metastases
to the liver, brain and adrenal glands. The patient
also had acanthosis nigricans.
The meeting was adjourned at 10:00 p.m.
Collation was served.
Attendance: 105.
661
PHLEBITIS
concluded from page 631
bolism, a major operation such as a vena cava divi-
sion should not be done. Sometimes a large clot
may be present and give a few physical signs. In
such cases I believe the electrocardiogram is of
value in demonstrating right heart strain. If this is
the case, anticoagulant therapy rather than vena
cava division is the choice.
Many physicians believe that a vein division pro-
duces a higher percentage of the postphlebitic syn-
drome than other methods of treatment. This is
very difficult to evaluate, and I know of no defini-
tive study. From our own experience, I believe that
the postphlebitic syndrome is more closely related
to the severity of the initial phlebitis than to the
type of therapy used.
REFERENCE
1Byrne, J. J.: Phlebitis: A Study of 748 Cases at the Bos-
ton City Hospital. The New England J. Med. 253 :579-586
(Oct.) 1955
Curran & Burton, Inc.
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MAGAZINE SUBSCRIPTIONS
Subscriptions for all types of magazines
including medical journals, also renewals
of subscriptions, arranged for your home
and office.
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Patronize Journal Advertisers
RHODE ISLAND MEDICAL JOURNAL
WHAT HAVE YOU TO SAY
ABOUT HOSPITAL ACCREDITATION?
In June, 1955, the House of Delegates of the American Medical Association
authorized the Speaker to appoint a committee “. . . to review the functions of
the Joint Commission on Accreditation of Hospitals...” and “. . . to make an
independent study or survey and report its findings and recommendations to
the House of Delegates at the next annual meeting. All physicians and hos-
pitals are urged to pass on to this special committee any observations or
suggestions concerning the functioning of the Joint Commission on Accredit-
ation of Hospitals.”
This Committee was appointed, and now, in undertaking the task assigned
to it, is seeking to obtain from physicians and others their observations con-
cerning the functioning of the Joint Commission.
It is obviously impossible for the Committee to contact all physicians and
others who may have observations or comments concerning the matter of
hospital accreditation.
The Committee, therefore, is publishing this appeal, through the coopera-
tion of the RHope IsLtaAnD MeEpIcAL JOURNAL, to obtain a cross section of
observations concerning the accreditation program.
The Committee is interested especially in the following:
1. The general understanding by physicians of the functions of the Joint
Commission.
2. Whether the method of appeal from an adverse ruling regarding ac-
creditation is satisfactory.
3. The effect on the individual physician’s hospital connections due to
actions of the Joint Commission.
4. Whether any organizations not now represented should have official
representation on the Joint Commission.
5. The effect of the Joint Commission’s requirements concerning such
matters as staff meetings.
6. The pros and-cons of separating administrative and professional ac-
creditation functions in the inspection of hospitals.
7. Constructive suggestions for improving the hospital accreditation
program.
Any comments from individual members or state and county societies
should be addressed to:
W. C. Stover, M.D., Chairman
Committee to Review Functions of Joint
Commission on Accreditation of Hospitals.
535 North Dearborn Street
Chicago 10, Illinois
These comments should reach the chairman not later than January 15, 1956.
W. C. Stover, M.D., Chairman, Boonville, Indiana
John F. Burton, M.D., Oklahoma City, Oklahoma
Gerald D. Dorman, M.D., New York, New York
George F. Gsell, M.D., Wichita, Kansas
Eugene F. Hoffman, M.D., Los Angeles, California
T. C. Terrell, M.D., Fort Worth, Texas
George Unfug, M.D., Pueblo, Colorado
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